Unilateral Atresia Research Articles

Congenital atresia of posterior nares: Diagnosis and treatment at Hilla, Iraq

Abstract Background: Atresia of posterior nares (choana) is a congenital condition in which the posterior nares fail to develop either bilaterally or unilaterally. Objectives: The aim of this article is to show different methods of diagnosis and surgical procedures used for management in our department. Materials and Methods: In this study, 21 patients were included. It is a retrospective study form. The confirmation of the diagnosis is by failure of 6–8-F tube catheter to pass; CT scan of posterior choana shows the type and thickening of atretic plate (cartilage or bone), and endoscopic examination confirms it. Results: Female patients were 15, whereas male patients were 6. Age range was from 1 day to 25 years. All of the patients were within the pediatric age group except one adult patient. Unilateral cases were found in 14 patients, while 7 patients had bilateral atresia. Bilateral atresia was presented within early day life (1–3 days). They were five females and two males. The unilateral cases diagnose at a later life period (4–25 years). There were 4 males and 10 females. Proved by CT scan, mixed bony and membranous atresia were in 18 patients, bony atresia was in 3 patients, and there was no pure membranous atresia. Thirteen of the unilateral cases involved right side, while only one case had left-side atresia (7.6%). Three cases of bilateral atresia had other congenital anomalies (14%). Ten patients were treated by nonendoscopic (transnasal) surgical approach (five of them had bilateral and unilateral atresia, respectively). Endoscopic trans-septal approach was done in two patients, both had bilateral atresia. Nine patients were treated by transnasal endoscopic method. Stent was used in 13 patients postoperatively for 4–6 weeks. Two patients required revision surgery for restenosis. Conclusion: Endoscopic transnasal approach is the proper way in the surgical treatment of atresia because it is more accurate, under surgeon vision, less invasive with less morbidity in spite of longer time to perform.

Practical Tips for Surgical Management of Bilateral Choanal Atresia.

Choanal atresia refers to congenital blockage of posterior choana of nose by the presence of a bony or membranous soft tissue. It causes respiratory distress innewborn which requires emergency surgical intervention. Various surgical methods areavailable for correction of choanal atresia and endoscopic approach is the commonlyused one. However there is risk of re-stenosis after surgery. This article focuses onsurgical refinements to improve the surgical outcome.It is a retrospective study done on eight newborns with bilateral congenital choanalatresia. Data included gestational age, any ante-natal issues, breathing activity at birth, diagnostic tests for choanal atresia and Head to Foot examination findings. Initialdiagnostic work up included CT scan of paranasal sinus and Echocardiography to ruleout associated cardiac anomalies. All the newborns were treated initially in NICU withventilator support and then taken up for endoscopic correction of atresia. After surgery, newborns were successfully weaned off from ventilator.Among the 8 newborns, there were 5 males and 3 females and their gestational agewas full term. (except in one). Initial presentation included respiratory distress on day 1of life with difficulty in inserting feeding tube through the nose. Imaging showedbilateral atresia in 7 newborns and unilateral atresia in one newborn. 5 of themunderwent atresia surgery using endoscopic approach. One newborn required revisionsurgery. Remaining newborns remained symptom free during the follow up period.Currently endoscopic approach remains a safer method for correction of choanalatresia with very minimal chance of re-stenosis. Surgical refinements like adequatewidening of neo-choana and usage of mucosal flaps to cover the raw area has beenfound to improve the surgical outcome.

Treatment of choanal atresia in a cohort of 29 patients: Determinants for success or failure

BackgroundChoanal Atresia is a congenital condition that presents as a blockage from the nasal cavity to the nasopharynx. According to the German statistical Institute (Statistisches Bundesamt), the incidence in Germany in 2018 reached 2.74 in 10,000 live births.It can present unilaterally or bilaterally. As newborns are obligate nasal breathers, management of bilateral atresia has to be performed early after birth. As for unilateral atresia, the optimal age for treatment was determined to be between 6 and 12 months in a recently published consensus. ObjectiveThe main purpose of this study is to characterize the patients treated for choanal atresia in the Department of Otorhinolaryngology and Head and Neck Surgery at a tertiary hospital in the south of Germany and, based in the demographic characteristics as well as intra- and post-operative treatment, to identify factors for success or failure of the surgery. A secondary goal was to describe the complications in the use of stents and analyse its influence in the results. Material and methodsThe cohort-based observational study included 29 patients, with a minimum follow up of one year, who underwent surgical endoscopic correction of both unilateral and bilateral choanal atresia from 2003 to 2020. Analysis of the demographics, intraoperative, and postoperative treatment, and their results, was performed.Multinomial logistic regression was applied for categorical values. Comparisons were performed using Fischer/chi-square test where applicable. A significance level of 0.05 was reached. ResultsThe population was comprised of 34.5% male and 65.5% female patients. The age varied from 2 days to 20 years old, with a mean of 4.98 years and Standard Deviation (SD) 6.88. The weight of the patients varied between 1.4 kg and 85.0 kg, with a mean of 19.36 and SD 22.58. Unilateral choanal atresia was present in 58.6%, and bilateral in 41.4%. Out of this population, 48.3% presented with associated malformations.The number of procedures per patient performed in general anesthesia varied from 1 to 9, with a mean of 2.52 and SD of 2.23: statistically higher for patients presenting with bilateral atresia with a p value of 0.001*. 20 patients had a tube (Vygon, France) placed at first surgery. In 5 patients, a drug-eluting stent (Propel mini (R); Intersect ENT, USA) was applied intraoperatively, without complications.In unilateral choanal atresia, surgical and functional success was attained in 88.2% of the cases. In bilateral cases, it reached 75%.We observed a strong linear relationship between the weight of the patient and the size of the choana perioperatively: R quadrat 0.596, which may be a determinant factor in the wound healing.Weight, age, and concomitant pathology achieved statistical significance in the logistic regression model (p respectively 0.001*, 0.001* and 0.010*), which shows its influence in the result of the surgery. In particular, weight inferior to 3 kg (p 0.001*, chi-square test) at the time of the first surgery is a determinant demographic factor for need of revision in order to achieve patency.There were no major complications associated with the use of a stent, besides its dislodgement. We could not infer an implication of its use on the success of the surgery in the present cohort. Limitationsfor this study were the small size of the cohort and non-standardized records for some variables. ConclusionsYounger patients presenting with low weight and concomitant pathology have worse results after surgical endoscopic treatment of choanal atresia, revealing these characteristics to be determinant for success. The size of the neochoana is related to the weight of the patient, which is a limiting factor.In particular, patients under 3 kg had to undergo more procedures in order to achieve patency.The implication of the use of locally applied medication needs to be further studied.

Incidentally diagnosed unilateral pulmonary venous atresia in a 63-year-old patient with advanced carcinoma sigmoid colon: a case report

Incidentally diagnosed unilateral pulmonary venous atresia in a 63-year-old patient with advanced carcinoma sigmoid colon: a case report

Unilateral Choanal Atresia: Indications of Long-Term Olfactory Deficits and Volumetric Brain Changes Postsurgically

Background: Very few studies have investigated whether unilateral choanal atresia is associated with permanent olfactory deficits. Objective: This study aimed to evaluate the olfactory performance of patients with unilateral choanal atresia postsurgically. Methods: Three patients with unilateral atresia were examined in terms of olfactory performance with the Sniffin’ Sticks test (odor identification, threshold, and discrimination), size of the olfactory bulb, and volumetric brain changes. Results: All patients demonstrated significantly lower olfactory performance in terms of odor threshold on the same side with the choanal atresia. Grey matter reductions were found ipsilaterally in the hippocampus. Conclusions: This pilot study indicates that persistent olfactory deficits and volumetric brain changes are present in patients with unilateral choanal atresia.

Congenital aural atresia surgery: anterior mastoid and transmastoid approaches

BackgroundAural atresia (CAA) is a congenital abnormality with hypoplasia or aplasia of the external auditory canal. Surgical procedures of CAA is not only difficult but has still not been embraced by surgeons. Many surgeons are doubtful to perform a repair due to poor hearing results and the risk of new canal stenosis. This article describes the writers’ expertise with surgical management of aural atresia. A retrospective study of 16 cases of CAA was undertaken in the Hearing and Speech Institute between 2015 and 2018. The study consisted of 16 patients, 8 patients for each group, 10 males and 6 females between 4 and 18 years of age with a median age of 6 years. Ten patients had bilateral atresia, and 6 had unilateral atresia. Postoperatively, patients were tested for hearing recovery and follow-up lasting up to 2 years to record any complications. Purpose of the study was to compare hearing effects and risks of anterior and transmastoid approaches to external and middle ear restoration in patients with CAA.ResultsAll patients were satisfied with the surgery by improving the hearing up to 35 dB or less after 12 months. Four patients (25%) developed soft tissue meatal stenosis, with 2 patients in each group. There were no cases of bony canal stenosis. TM perforation was seen in two patients (12.51%), one patient in each group. Lateralization of the graft was seen in one patient in the transmastoid group, and no ossicular chain refixation. Five cases had postoperative otorrhea, one in the anterior mastoid group and four in the transmastoid group. There were no other complications.ConclusionsAlthough the findings of the hearing are close. The previous approach, due to fewer postoperative complications, is now our favorite technique. Proper alignment and soft-tissue strategies are keys to the effective correction of the congenitally atretic ear canal.

Nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants

Objective: To describe and evaluate the surgical effect and prognosis of nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants. Methods: The clinical data of 38 newborns and infants with congenital choanal atresia who underwent nasal endoscopic surgery in Beijing Children's Hospital between January 2016 and May 2018 were retrospectively analysed, including 13 males and 25 females. The age ranged from 5 days to 3 years old at the time of operation (15 cases were newborns). The clinical data, imaging data, treatment effect and prognosis were collected. According to the different surgical methods, the patients were divided into the conventional operation group and the modified mucosal flap technique group. The designs of the modified mucosal flap technique were designed according to the type of congenital choanal atresia. The cross-over L-shaped flaps were performed in patients with unilateral atresia, and the mirrored L-shaped flaps were performed in patients with bilateral atresia. All the patients were followed up for 2-3 years, and the follow-up parameters included the times of operations, length of hospital stay, restenosis rate and incidence of complications. Study data was analyzed using SAS version 9.4 statistical software. Results: Sixteen cases underwent conventional operation while 22 patients underwent modified mucosal flap technique under nasal endoscope. The lightest weight (2 200 g) and the youngest age (5 days) of the patients came from the modified mucosal flap technique group. Compared with the conventional operation group under nasal endoscope, the modified mucosal flap technique group had fewer times of operations (1.14±0.47 vs 2.69±1.20, t=5.552, P<0.001), shorter hospital stay ((7.70±3.22) d vs (14.37±19.16) d, t=2.960, P=0.005), lower rate of postoperative restenosis (9.1% vs 43.8%, χ²=6.156, P=0.013), and lower rate of the incidence of complications (13.6% vs 43.8%, χ²=5.955, P=0.015), the differences were statistically significant. Conclusion: The nasal endoscopic modified mucosal flap technique is feasible for repairing congenital choanal atresia in newborns and infants, which can significantly reduce the incidence of postoperative restenosis and complications.

Features and Strategies in the Management of Choanal Atresia: A 6-Year Retrospective Analysis.

Choanal atresia although rare, is the most common inborn nasal deformity and an important cause of newborn airway obstruction. This study aims to describe a single-center experience in the management of choanal atresia and emphasize the ambiguous issues regarding its surgical repair. The authors retrospectively analyzed the treatment strategy of 18 patients with choanal atresia and their outcomes during the follow-up period. Bilateral choanal atresia was diagnosed in 9 patients, 6 of those had mixed bony-membranous type (67% versus 33% who had pure bony type). Almost half of the 18 patients had a mixed bony-membranous type of atresia (56%). Interestingly, 89% of patients with bilateral atresia underwent transnasal endoscopic repair with stenting, compared to 44% of those with unilateral atresia (P = 0.04). A trend to preference of stent procedure in patients with bony type was also observed, in comparison with mixed bony-membranous type (89% versus 50%, P = 0.09). No significant difference in the need for revision treatment was noticed among the two treatment groups. Both in our data and literature there is no clear supremacy of stenting. Considering the high incidence of re-stenosis, all patients should be under close follow up for a long-term period. Inevitably, further investigation is necessary to establish an ideal surgical procedure.

Nasal Cavity CT Imaging Contribution to the Diagnosis and Treatment of Choanal Atresia

Background and Objectives: Choanal atresia is the most common congenital malformation of the nose. Materials and Methods: We have evaluated 24 CT images of children with choanal atresia treated at the Department of Pediatric Otorhinolaryngology FM CU and the NICD Bratislava (Slovakia). In accordance with the methodology used by Slovis et al. (1985), we have measured parameters related to anomalous development in the nasal cavity: vomer width, the width of soft atresia and the width of the air space of unilaterally developed choana. Results: In the group of 24 patients, 11 (46%) were male and 13 (54%) were female. The age of patients at the time of CT imaging varied. Associated syndromes had been manifested in 11 (46%) children, with 7 (29%) patients having CHARGE syndrome. In 13 (54%) cases it was a bone membranous type of atresia, in 8 (33%) cases a membranous type, and in 3 (13%) patients a bone type. Among the group of patients, unilateral disorder was present in 13 (54%) patients and bilateral in 11 (46%). Based on the Pearson’s correlation test, we have found in the studied group that the width of the vomer correlates with age, and the vomer is wider in bone atresia than in the membranous ones. Based on determining the average vomer’s width within the age groups 0–8 and >8–20, compared to the standard widths, we found that the vomer’s widths reached the upper limits of the standard ±2 SD (cm) or even exceeded that limit. The same applies to the width in soft choanal atresia. On the other hand, the width of the developed choana in the case of unilateral atresia is almost standard. Conclusions: The above findings are the basis for selecting the appropriate type of surgery. Currently, the gold standard is the endoscopic fenestration. associated with posterior septotomy.

Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: a retrospective study

BackgroundMultiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and evaluate outcomes of the endoscopic septonasal flap technique combined with bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants.MethodsClinical data of 37 neonates and infants with congenital choanal atresia who received nasal endoscopic surgery with the flap technique between January 2018 and July 2020 were analyzed retrospectively. All patients underwent the ultra‑low‑dose paranasal sinus computed tomography imaging preoperatively to confirm diagnosis and plan the surgery. In these patients, the mirrored L-shaped flap technique was performed for bilateral atresia and the cross-over L-shaped flap technique was performed for unilateral atresia. A total of 22 patients had silicone stents postoperatively and 15 patients had bioabsorbable steroid-eluting stents postoperatively. Silicone stents were removed at one month postoperatively under secondary general anesthesia, while no anesthesia was needed to remove the bioabsorbable steroid-eluting stents. Postoperative follow-up ranged from 10 months to 3 years.ResultsThe septonasal flap technique was performed in all patients. Compared with the silicone stents group, the average operative duration and the hospital length of stay in the bioabsorbable steroid-eluting stents group were decreased [(97.46 ± 15.37) min vs (83.49 ± 19.16) min t = 13.733, P < 0.001] [(12.8 ± 3.22) d vs (7.67 ± 3.91) d t = 15.082, P < 0.001], the average number of procedures was reduced [(2.04 ± 0.64) vs (1.00 ± 0.00), t = 82.689, P < 0.001], the differences were statistically significant. There were no reports of postoperative restenosis and complications in the bioabsorbable steroid-eluting stents group, and follow-up endoscopic examinations showed patency and stable nasal passages in all cases.ConclusionsThe endoscopic septonasal flap technique can effectively expose and expand the choanal bony structure for repair of congenital choanal atresia in neonates and infants. The combined use of this technique along with bioabsorbable steroid-eluting stents can help prevent the need for revision procedures and also against stent-related injuries.

Clinical retrospective analysis of 15 cases of choanal atresia - Our experience.

ObjectiveChoanal atresia is a rare congenital disorder due to failed recanalization of the nasal fossae during fetal development. This article focuses on our experience in dealing with choanal atresia and its management. Here we discuss the varied clinical symptoms that the patients presented with, the clinical tests and investigations that were specific in diagnosing this condition and surgical management of these cases with endoscopic transnasal choanaplasty with stenting and follow up topical Mitomycin C application.Material and methodsThis is a retrospective study based on computerized medical record review of the patients born in Department of ENT of Sur Hospital between 2002 and 2017. The patients were assessed with detailed history, presentation of clinical symptoms and all underwent nasal endoscopy and CT scans for assessing the atretic type. These patients underwent transnasal endoscopic choanaplasty under general anesthesia using microdebrider and stented using endotracheal tube. The patients were regularly followed up for review with nasal endoscopy after discharge between 4th and 7th postoperative period. The parents were educated on nursing care and the stent was removed in 4 weeks, all patients had Mitomycin C applied to the neochoana and were on regular follow up for a year with no recurrence.ResultsFifteen patient records were analyzed, 10 females and 5 males, ages varying from newborns up to 14 years old. Unilateral to bilateral choanal atresia was 4:1 ratio and female-male showed 2:1 ratio. Right malformation was predominant in both sexes in unilateral atresia. Mixed imperforation (bone-membranous) was the most frequently observed type, followed by bone malformation. The commonest symptom during diagnosis was rhinorrhea and the least one was respiratory failure. Majority of cases were diagnosed by CT scans of sinuses. Around 10% patients presented with cardiac problems. None had restenosis in one year follow up.ConclusionsNeonates with acute respiratory insufficiency due to choanal atresia can be diagnosed with simple bedside tests like cold spatula test, less invasive tests like failure to pass intranasal catheter, CT scan. Surgical correction with endoscopic intranasal choanaplasty is the way to address this problem and could avoid radical palatal approach, less morbidity and high success rate.

Anesthesia management in patients with choanal atresia

In this retrospective study, we reviewed the anesthesia management of patients with choanal atresia (CA). Fourteen patients undergoing surgery for CA between June 2007 and September 2018 were evaluated for age, gender, CA side, complications, American Society of Anesthesiologists score, duration of anesthesia, and presence of any additional anomalies. Six patients (42%) had bilateral atresia, and 8 (58%) had unilateral atresia. Various congenital anomalies were present in 50% of patients with bilateral atresia. Three patients were intubated with a C-MAC D pediatric blade because their Cormack-Lehane grade was 3 or 4. Though sevoflurane was used for all patients, total intravenous anesthesia was used for two patients with unilateral atresia. All patients were followed postoperatively while intubated except one patient with bilateral atresia. There was no need for postoperative intubation of any patients with unilateral atresia. In conclusion, clinicians should be aware of perioperative and postoperative complications in patients with CA, bilateral atresia, and accompanying congenital anomalies in the neonatal period. Total intravenous anesthesia can be chosen instead of inhalation anesthesia in appropriate cases, but sevoflurane can be used safely in the induction of anesthesia.

Atresioplasty for congenital aural atresia: A not so gloomy outlook

Introduction: Congenital aural atresia (CAA) is an abnormality of the external ear along with hypoplasia or aplasia of the external auditory canal. Surgery of aural atresia is not only challenging but also has not been accepted by the surgeons. Many surgeons hesitate to undertake the repair due to inadequate hearing outcome and probability of stenosis of the new canal. This report presents the authors' experience of surgical treatment of aural atresia. Materials and Methods: A retrospective analysis of 31 cases of CAA operated during 2002–2018 in a tertiary referral center was performed. Unilateral atresia was more common. A combined anterior and posterior approach was employed in all the cases. Postoperatively, the patients were evaluated for hearing improvement and any sequelae of surgery at varying period up to 3 months. Results: Twenty-eight patients underwent surgery after exclusion of three patients due to diploic mastoids. A postoperative air-bone closure of >25 dB was achieved in 15 out of 28 patients. Five patients had air-bone closure of 15–25 dB. Only 8 patients did not have any hearing improvement. Meatal stenosis occurred in 2 patients. There were no other complications. Conclusions: Patients with CAA of moderate grade favorable radiological findings may benefit with surgery for better hearing outcomes. Bone-anchored hearing devices can be advised if the surgery is not feasible, particularly in high-grade atresia and unfavorable radiology.

Endonasal endoscopic surgery of choanal atresia - long term results

Choanal atresia is a rare abnormality. As neonates depend on transnasal respiration, bilateral choanal atresia causes an acute emergency. Transnasal endoscopic resection of congenital choanal atresia is a well-established therapy. However, the surgical technique has not yet been standardized. A retrospective chart review was performed with a follow-up examination between 9 to 87 months after surgery. 11 patients (7 with unilateral atresia, 4 with bilateral atresia) were included. The choana was opened and enlarged endoscopically by resection of the posterior septal wall and bony reduction up to skull base and nasal floor. Intraoperative handling, intra- and postoperative complications, restenosis and adequate respiratory function were assessed. No intraoperative complications could be observed. Three premature babies underwent surgical intervention within their first postnatal week with an average weight of 2540 g. 2/11 patients suffered from a minor episode of epistaxis as a postoperative complication. Long-term success without restenosis was 73 % (for unilateral atresia) and 100 % for bilateral (atresia). Choosing an endonasal endoscopic approach to resect choanal atresia via resection of the posterior septal wall and circular bony reduction is a successful therapy with low morbidity.

Comprehensive management of congenital choanal atresia

ObjectivesTo present results of a one-stage minimally invasive surgical procedure for congenital choanal atresia (CCA). Seven outcome measures were applied. Materials and methodsRetrospective study conducted between 1999 and 2015. The same endonasal endoscopic approach with multiflaps and no stenting was used on 36 children. The flaps were attached with fibrine glue. There were 50% unilateral and 50% bilateral cases, 70% primary and 30% secondary surgery. The mean age at primary surgery for bilateral atresia was 10 days and for unilateral atresia 4 years. Associated loco-regional disorders were: hypoplasia of the inferior turbinate, rhinopharyngeal stenosis and rhinopharyngeal web. ResultsThe average follow-up time was 6 years, ranging from 1 to 14 years. There was a functionally patent choanae in 94% of children, and 6% showed severe restenosis with a diameter less than 4 mm, which needed one revision surgery each. Charge patients were not associated with worse outcome. There was no external nasal valve stenosis and no permanent Eustachian tube dysfunction. Synechiae occurred in 3 patients with hyperplastic inferior turbinate. No patients showed any disharmonious nasal growth. In neonates with isolated bilateral CCA, breast-suction could be started within 1 day (range 1–2 days), and pain-killers were needed on average for 1.5 days (range 1–4 days). The hospital stay for unilateral isolated CCA was on average 1.5 days (range 1–2 days) and for bilateral isolated CCA, 8 days (range 3–20 days). Postoperative procedures under a short general anesthesia were necessary in 12 cases, 10 of them were infants under 6 months of age. ConclusionSurgery could be performed safely in the newborn in the early stage of life, even for unilateral atresia. Tendency for restenosis can be minimized by: 1. the construction of an as large as possible uni-neochoanae by removing the posterior part of the vomer and by drilling away the medial pterygoid; 2. in case of rhinopharyngeal stenosis, part of the endochondral clivus bone should be resected; 3. all raw surfaces should be covered by multiple mucosal flaps secured with fibrin glue; 4. no stenting; 5. appropriate postoperative care.

Unilateral atresia of the pulmonary veins: a case report

Unilateral atresia of the pulmonary veins: a case report

Maturation of auditory brainstem responses in young children with congenital monaural atresia

ObjectiveTo date, the impact of conductive hearing loss on the auditory pathway at brainstem level has only been investigated in animal studies, which showed a species-specific delay of maturation. In this study, the functional maturation of auditory brainstem response (ABR) parameters in humans with unilateral atresia of the external auditory canal was investigated. Methods42 newborns and toddlers ranging in age from 13 days to 11 months were included. The click-evoked ABR interpeak latencies (IPL) of the atretic ears and the contralateral ears with normal hearing were evaluated. The children had no comorbidities and had never been fitted with any kind of hearing aid. The absolute latencies (AL) and IPL of a matched control group were compared to the contralateral normally hearing ears of the children with unilateral atresia. ResultsThe mean air-bone gap in the ears with atresia was 44 dB HL. Despite this partial acoustic deprivation, no significant difference between the IPLs of normal ears and ears with atresia could be detected. Both for AL and IPL, the differences between the normal ears and the control group were all within 1 standard deviation to the mean. ConclusionThe data showed that the monaural acoustic deprivation by a block of sound conduction does not produce any delay of functional maturation at brainstem level in this group of patients. With regard to the AL and IPL on brainstem level, no differences between the normal ears of children with unilateral atresia and children with bilateral normal hearing could be detected.

孤立性片側肺静脈閉鎖症の3例

孤立性片側肺静脈閉鎖症の3例

Anesthesia Management in Patients With Choanal Atresia.

In this study, the anaesthetic management of newborn and infant patients who underwent surgery for choanal atresia between 2009 and 2016 is discussed in the light of recently published literature. The diagnoses, demographic data, anaesthetic risk and duration, additional anomalies, airway management, and complications that arose in 41 patients with choanal atresia who were operated on between 2009 and 2016 were evaluated retrospectively by examining their medical and anaesthesia records. The patients were divided into 2 groups: Group I-bilateral choanal atresia and Group II-unilateral choanal atresia. Of the 41 patients included in the study, 24 (58.53%) were in the bilateral group, and 17 (41.46%) were in the unilateral group. Fifteen (34.1%) of the patients were male, and 26 (59.1%) of the patients were female. The mean age of the 24 patients in Group I was 25.86 days (3-72), and the mean age of the 17 patients in Group II was 171.08 days (81-365). Additional congenital anomalies were present in 13 of the patients in the bilateral choanal atresia group and 3 of the patients in the unilateral choanal atresia group.Seven patients from Groups I and 2 patients from Group II were determined to have difficult airways. The laryngoscopic images from these patients were classified as grades 3 and 4 according to the Cormack-Lehane classification system. When the durations of anesthesia in the groups were compared, the duration of anesthesia in Group I was found to be significantly longer (Table 3). Anesthesia-related complications were observed in 9 patients (37.5%) from the bilateral choanal atresia group and in 4 patients (2.3%) from the unilateral atresia group. Steroids were used as prophylactics in these patients. Congenital anomalies and their associated risks, as well as intubation and ventilation problems and the complications that might arise, must be considered in addition to anesthetic management when repairing choanal atresia in newborn and infant patients.

Endoscopic management of congenital choanal atresia: Second look is mandatory

Congenital choanal atresia (CA) is a rare abnormality characterized by unilateral or bilateral obstruction of the posterior end of the nasal cavity. With an incidence of 1:1000 to 1:8000 births, it is more in female than in males and unilateral more common than bilateral. Surgical procedures aim to provide adequate functional choanal patency and a low rate of rest enosis, with shorter surgery and hospitalization times, to minimize morbidity and mortality, this study done to evaluate the effectiveness and safety of endoscopic nasal surgical techniques for the treatment of congenital choanal atresia in patients with unilateral and bilateral atresia and to emphasis in the important of second look procedure at the time of removal of stent to assess the wideness of neochoana, and to remove any granulation tissue ,or polyps, it involved 13 patients, 10 with unilateral CA and 3 bilateral CA, all involved in surgery and second look.Bangladesh J Otorhinolaryngol; October 2015; 21(2): 76-79