Neonatal Nasal Obstruction Research Articles

Neonatal Nasal Obstruction: A Comprehensive Analysis of Our 20 Years' Experience.

Neonates are obligatory nasal breathers hence nasal obstruction is a very important symptom to be evaluated. Although causes can be trivial most of the time, they can be life-threatening in some. Respiratory distress immediately after birth, feeding difficulties, paradoxical cyanosis, and failure to thrive are the most evident symptoms, and determination of unilateral or bilateral involvement guides the rationale for elective or emergency intervention. This study aimed to evaluate the causes, presentation, and management of neonates with nasal obstruction. We collected the data of all the neonates evaluated for nasal obstruction at our hospital over the past 20years from June 2003 to May 2023 and assessed the strategy of approach for diagnosis and management of those cases. In our study, the commonest cause for neonatal nasal obstruction was found to be choanal atresia and the rarest was iatrogenic. A variety of other causes were also reported. As neonatal nasal obstruction has a multitude of rare causes each carries a unique assessment and treatment plan. History taking and clinical examination are the most important parts of evaluation including endoscopic evaluation in an office-based setup. Imaging studies add to the evaluation of cases of anatomical obstructions and associated anomalies (syndromes). Early diagnosis and swift intervention can be life-saving. The need for follow-up visits and second-stage corrections should be emphasized in getting the best long-term results.

Rare causes of congenital neonatal nasal obstruction leading to respiratory distress at birth and its management: A case series

Neonatal nasal obstruction may present as an acute respiratory emergency. Neonates primarily are obligate nasal breathers. Hence, any nasal obstruction whether arising due to skeletal or anatomical anomalies or due to nasal mass or cyst can present with cyanosis, stridor, feeding problems, and/or failure to thrive. Although choanal atresia remains one of the most diagnosed nasal anatomical anomalies leading to this problem; other rare causes of neonatal nasal obstruction, namely, midnasal stenosis, pyriform aperture stenosis, congenital nasal mass, or cyst should also be considered. Hence, a thorough evaluation with diagnostic nasal endoscopy along with an imaging modality (computed tomography/magnetic resonance imaging) is warranted. Management whether conservative or surgical intervention is guided by the severity and nature of the symptoms. This series highlights our experience of four different case scenarios of respiratory distress arising out of nasal anatomical anomalies and its subsequent management and outcome.

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Congenital nasal pyriform aperture stenosis with holoproencephaly: Diagnosis and surgical management

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal nasal obstruction that clinically mimics choanal atresia. It occurs as a result of abnormal development of primary palate and maxilla, either in isolation or in association with other anomalies. Differentiation between CNSPAS and choanal atresia is critical as management approachers are quite different from one another. Diagnosis can be made clinically and with characteristics CT findings. Management options include both conservative and surgical approaches depending on the patient’s initial condition. Here is reported a case of 33 days infant who was admitted to our NICU with a working diagnosis of CNPAS after she presented with two days of fast breathing and failure to suckle, managed surgically and discharged improved.

Congenital nasal pyriform aperture stenosis: Diagnosis, management and technical considerations

BackgroundCongenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of nasal obstruction in neonates with respiratory distress manifestations. Diagnosis is made with craniofacial computed tomography, prompt and precise treatment creates good outcomes in these patients. AimTo present our experience in diagnosis and management considerations with this rare pathology and a case series of our surgically managed patients. MethodsA retrospective, analytical study of CNPAS patients surgically managed over a period of seven years. Evaluation and follow up was reviewed. ResultsThirteen patients were evaluated; pyriform aperture mean width was 5.5mm. Of these patients, 31% also had Congenital Midnasal Stenosis. Medical treatment failed for all the patients and they required surgical enlargement of the pyriform aperture. No complications were seen and all patients improved in symptoms and development. ConclusionsCongenital nasal obstruction can be fatal in new-borns, CNPAS is a rare differential diagnosis that must be completely evaluated, properly treated with conservative management and if it fails, with well-planned and executed surgery. Follow-up shows high rates of success.

Congenital midnasal stenosis: Conservative management

IntroductionCongenital midnasal stenosis (MNS) is an extremely rare disease which may be life threatening, and shows difficulty in diagnosis and management. This case series summarizes superiority of using intranasal mometasone furoate spray (IMS) and continuous positive airway pressure (CPAP) to treat nasal obstruction in neonates with MNS. MethodsThis study reviewed six consecutive cases of MNS. ResultsThree patients were treated with IMS and CPAP. Two patients were treated with endoscopic balloon dilatation without stenting, followed by IMS and CPAP due to persisting nasal obstruction after the operation. One patient was treated with endoscopic balloon dilatation without stenting alone. ConclusionThis study is the first to review the use of CPAP and IMS as an effective therapy for some patients with MNS. It suggests that conservative management with CPAP and IMS may be an alternative therapeutic option to surgery.

Clinical and imaging evaluation of Congenital Midnasal Stenosis

ObjectivesTo illustrate the clinical and radiological presentation of a rare etiology of nasal obstruction in neonates, midnasal stenosis (MNS), including a comparison of nasal dimensions with those of normal infants. MethodsWe retrospectively reviewed medical charts and computerized tomography (CT) imaging of neonates with nasal obstruction diagnosed as stenosis in the midnasal area in a tertiary pediatric medical center. MNS was defined clinically by inability to visualize the middle turbinate with an endoscope despite the absence of stenosis of the anterior aperture or any gross septal deviation. CT measurements of the midnasal width were taken by an experienced neuroradiologist. We compared widths between the bony inferior turbinate to the bony septum in the narrowest area of symptomatic patients, to widths in a control group of asymptomatic children. ResultsNine neonates from birth to three months old presenting with nasal obstruction, severe stertor, and blocked nasal passage at the midnasal level in endoscopic examination, were diagnosed with MNS. 6/9 had CT scans. Four had isolated unilateral stenosis, two unilateral MNS and contralateral choanal atresia, and three bilateral MNS. All patients were managed conservatively, initially with nasal saline irrigation and local steroids and topical antibiotics; Median time to resolution of symptoms was 14 days.When comparing the dimensions at the midnasal narrowest area of the stenotic group with a control group of 139 healthy children, the median bony width was 1.7 mm vs. 3.2 mm, respectively (p < 0.00001). Average dimensions according to age groups until the age of 12 months are given. ConclusionIn neonates with nasal obstruction, when choanal atresia and pyriform aperture stenosis are excluded, stenosis of the midnasal area should be considered. Most of these neonates can be managed conservatively. Level of evidence4.

Congenital nasal pyriform aperture stenosis: Diagnosis, management and technical considerations

BackgroundCongenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of nasal obstruction in neonates with respiratory distress manifestations. Diagnosis is made with craniofacial computed tomography, prompt and precise treatment creates good outcomes in these patients. AimTo present our experience in diagnosis and management considerations with this rare pathology and a case series of our surgically managed patients. MethodsA retrospective, analytical study of CNPAS patients surgically managed over a period of seven years. Evaluation and follow up was reviewed. ResultsThirteen patients were evaluated; pyriform aperture mean width was 5.5mm. Of these patients, 31% also had Congenital Midnasal Stenosis. Medical treatment failed for all the patients and they required surgical enlargement of the pyriform aperture. No complications were seen and all patients improved in symptoms and development. ConclusionsCongenital nasal obstruction can be fatal in new-borns, CNPAS is a rare differential diagnosis that must be completely evaluated, properly treated with conservative management and if it fails, with well-planned and executed surgery. Follow-up shows high rates of success.

Algorithm for the management of nasal obstruction in neonates and infants

The main cause of nasal obstruction in neonates and infants is inflammatory or infectious rhinitis. Congenital, neoplastic, traumatic or iatrogenic causes are less frequent. The pediatrician will alert to signs and symptoms of diseases less commonbut serious which should be diagnosed early. We present a proposal of simple algorithm for the management of unilateral and bilateral nasal obstruction in neonates and infants. We describe the pathologies that cause nasal respiratory failure, either those that occur very often or those which are important for their severity, their guiding symptoms to the presumptive diagnosis, additional studies and treatment.

Hypoplasia of the Maxilla: Differential Diagnosis of Nasal Obstruction in Infants

Introduction: The maxillary hypoplasia (MH) is a rare cause of respiratory distress in newborns (NB), which may be associated with genetic disorders such as holoprosencephaly and Apert syndrome. This pathology is part of the differential diagnosis of congenital nasal obstruction in neonates, along with choanal atresia and stenosis of the piriform aperture and nasolacrimal duct cyst.

Obstrucción nasal congénita por estenosis de la apertura piriforme. Serie de casos

Nasal obstruction in neonates is a potentially fatal condition due to their exclusive nasal breathing. The main cause is inflammatory or infectious rhinitis. Congenital, neoplastic, traumatic or iatrogenic causes are less frequent.Choanal atresia is the most common congenital nasal anomaly. A less common etiology of congenital nasal obstruction is pyriform aperture stenosis. Suspicion might arise in any newborn with varying degrees of stridor and respiratory distress, associated with the difficulty of passing a probe through anterior nares. Diagnosis should be confirmed by a computed tomography of the craniofacial massif. The therapeutic approach will depend on the severity of symptoms.We describe our experience with 5 patients with this condition, treated surgically using a sub-labial approach, and followed by nasal stenting.

"Double eyes" sign of congenital bilateral dacryocystoceles.

Dacryocystocele is caused by nasolacrimal duct obstruction and results in cystic dilatation of the proximal part of the nasolacrimal duct, which is located inferomedial to the orbit, leading to fluid accumulation. It is important to consider that persistent congenital bilateral dacryocystoceles may cause neonatal nasal obstruction resulting in respiratory difficulty, and large dacryocystoceles may require surgical drainage. Ultrasonography demonstrates that congenital bilateral dacryocystoceles and normal eyeballs prenatally resemble two pairs of cystic "lesions" of different sizes. We herein present a case of prenatally diagnosed isolated congenital bilateral dacryocystoceles and propose the new name of "double eyes" sign for this rare condition to create an impact on medical students and residents.

Obstrucción nasal congénita por atresia de coanas. Serie de casos

Nasal obstruction in neonates is a potential fatal condition because of their exclusive nasal breathing. The most common congenital causes include choanal atresia, dermoid cyst, glioma and encephalocele. Choanal atresia is the most common congenital nasal anomaly. When bilateral, it presents with respiratory distress at birth. Unilateral atresia is manifested by respiratory failure and unilateral rhinorrhea, and may go along unnoticed. Diagnosis is suspected in the absence of airfow in the nasal cavity and for the inability to advance a nasogastric tube. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and there are different techniques and surgical approaches. We describe our experience with 7 patients with this disease, successfully treated by transnasal endoscopic technique.

An unusual cause of nasal airway obstruction in a neonate: trans-sellar, trans-sphenoidal cephalocoele

Neonates are obligate nasal breathers, and nasal obstruction may have serious implications. We present an extremely rare cause of neonatal nasal obstruction, and its management. An eight-day-old neonate was referred for upper airway obstruction. Initial investigations had identified no obvious cause. Rigid airway endoscopy revealed a large, cystic lesion appearing to arise from the roof of the posterior nasal space. Computed tomography and magnetic resonance imaging indicated a basal cephalocoele projecting inferiorly into the oropharynx, with an intracranial connection to the pituitary fossa. Histology showed fibrovascular tissue lined on one aspect by respiratory type epithelium, with mucous glands present. The tissue contained multiple cystic spaces lined by choroid plexus epithelium, with glial tissue present in the walls of the mass. A transpalatal excision of the nasopharyngeal cephalocoele, with closure of the intracranial connection, palatal repair and lumbar drain placement was undertaken. Post-operative recovery was uneventful, with no evidence of cerebrospinal fluid leakage or palatal dysfunction. This surgical approach gave excellent access whilst avoiding the obvious morbidity associated with an intracranial approach. Nasal masses should be considered in the differential diagnosis of neonatal respiratory distress due to nasal obstruction.

Treatment of congenital nasal cavity stenosis by balloon dilatation in a newborn: A case report

Neonates are obligate nasal breathers, and any form of neonatal nasal obstruction may have serious consequences. Prompt diagnosis and appropriate treatment are essential to avoid severe hypoxia. Congenital bony nasal stenosis (CBNS) is an extremely rare cause of neonatal nasal airway obstruction and can easily be confused with choanal atresia or stenosis. This is a paper to describe a balloon dilatation technique that can be an effective alternative to surgery for the treatment of congenital nasal cavity stenosis, with minimal stress to the patient.

Congenital nasal pyriform aperture stenosis

Congenital pyriform aperture stenosis represents an unusual cause of nasal obstruction in neonates and is caused by overgrowth of the nasal process of the maxilla. A pyriform aperture width of less than 11 mm (Fig. 1) is diagnostic [1]. Its clinical presentation is similar to that of bilateral choanal atresia and may range from mild nasal obstruction to lifethreatening asphyxia. Up to 63% of the patients have a solitary median incisor (Fig. 2), thought to represent a mild form of the holoprosencephaly spectrum [2], in which case MRI of the brain and chromosomal analysis are also indicated.

Neonatal Nasal Obstruction

Neonatal nasal obstruction is a true emergency. It is preferable to establish an airway initially, which allows full evaluation of the problem. The newborn should be stabilized prior to embarking on definitive treatment, especially if other congenital anomalies involving multiple organ systems are present. Once the infant's situation is controlled, appropriate tests, such as diagnostic endoscopy and radiologic imaging, can be undertaken. Medical options should be considered initially. When appropriate, surgical therapy can be curative.

Neonatal nasal obstruction caused by bilateral dacryocystoceles

Dacryocystoceles, either unilateral or bilateral, occur when the nasolacrimal pathway is obstructed. They are the second most common cause of neonatal nasal obstruction after choanal atresia [1]. Obliteration of the nasal passage can occur when dacryocystoceles extend intranasally and can cause airway obstruction in neonates who breathe through their nose. The images are of a 7-day-old infant with a 5-mm soft, bluish nodule at the inferomedial right canthus and snorting respirations from birth. A coronal 2-D single-shot fast spin echo (SSFSE) T2-W image with

Congenital nasal pyriform aperture stenosis: a rare cause of neonatal nasal obstruction

Congenital nasal pyriform aperture stenosis has been described as an unusual cause of neonatal nasal obstruction. Clinical suspicion is based on respiratory distress, cyclic cyanosis, apneas, and feeding difficulties. A bony overgrowth of the maxillary nasal processes is thought to be responsible for this deformity. This anomaly has been reported as an isolated feature or can be associated with craniofacial or central nervous system anomalies. Surgery is indicated in cases of severe respiratory distress, feeding difficulties, and when conservative methods fail.

Neonatal nasal obstruction and a single maxillary central incisor

We present two neonates with nasal obstruction because of anterior choanal stenosis (congenital nasal pyriform aperture stenosis). An associated single maxillary central incisor was also shown on computed tomography imaging in the neonatal period. These midline anomalies are recognized minimal manifestations (microforms) of holoprosencephaly. We describe their neonatal investigation, multidisciplinary management and clinical course.