Bilateral congenital choanal atresia in a 16-year old girl at Muhimbili National Hospital, Tanzania

Abstract

Background: Bilateral choanal atresia refers to a congenital anomaly whereby a child is born with bilateral imperforate posterior nares. In most cases the diagnosis is established soon after birth. Establishment of the diagnosis requires a high index of suspicion by clinicians. The objective was thus to report an unusual case which went undiagnosed for many years and review the few available literatures.Case presentation: A 16-year old girl presented to the otorhinolaryngology clinic of Muhimbili National Hospital in Tanzania with a long standing history of bilateral nasal obstruction. The condition was reported to be present since birth and this was accompanied by mouth breathing and persistent bilateral nasal discharge. The patient also reported a history suggestive of respiratory distress after birth which necessitated oxygen therapy and difficulty in breastfeeding where she was kept on expressed breast milk during the first few weeks of life. Nasal endoscopy was done clinic and the diagnosis of bilateral congenital choanal atresia was made. Computerized tomography scan of the nose and paranasal sinuses revealed bilateral choanal atresia of mixed type. Surgical perforation of the atretic choanae without stenting was done endoscopically under general anaesthesia.Conclusion: Bilateral congenital choanal atresia is an otorhinolaryngological emergency and should be established promptly both in resource limited settings and in areas where advanced tools are in situ to prevent its morbidity and mortality if it goes unestablished.

Unusual Choanal Atresia in Children

“…In Makassar, Indonesia, a 16-day-old girl has been reported with bilateral CA (Perkasa 2013). At Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, there was only one case of bilateral CA throughout 2017 which is reported in this paper, a boy who was able to survive components, such as coloboma, heart deformity, choana atresia, stunted growth and development, genital abnormalities, and ear disorders (CHARGE), while Treacher Collins and Tessier syndromes are present in 4% of the cases (Bovo et al 2017, Maruvala et al 2017, Saitabau et al 2018, Wormald et al 2016. What the patient in this study had was bilateral CA with a facial deformity and congenital anomaly of lower extremities of CTEV.…”

Bilateral choanal atresia diagnosed in a 3-month-old female baby: a case report

“…In those with choanal atresia, the atretic plate may be bony (90%), membranous (5%), or mixed (5%) 9 , 10 . A computed tomography scan is recommended to establish the diagnosis and also as a guide during surgical perforation of the atretic choanae though this may be challenging in resource-limited settings 2 . The atretic choanal plate in the case we are hereby reporting was purely membranous in nature bilaterally, and this was reached by probing using an ear probe after the application of topical local anesthesia at the clinic.…”

“…Bilateral choanal atresia is a rare congenital anomaly where a newborn baby is born with bilateral imperforate posterior nares 1 , 2 . Such anomaly occurs due to a persistent oronasal membrane when it fails to break down at 38 weeks of gestational age 2 . In unilateral choanal atresia, the right nostril is commonly affected more than the left at a ratio of 2:1 2 – 5 .…”

“…Such anomaly occurs due to a persistent oronasal membrane when it fails to break down at 38 weeks of gestational age 2 . In unilateral choanal atresia, the right nostril is commonly affected more than the left at a ratio of 2:1 2 – 5 .…”

“…Unlike unilateral choanal atresia, which may go undiagnosed for a couple of years, its counterpart, named bilateral choanal atresia, is a neonatal emergency in most cases diagnosed immediately after birth since the affected newborns present with respiratory distress immediately after birth 1 . The reason why neonates with bilateral choanal atresia present with a state of respiratory distress immediately after birth is due to their behavior of being obligate nasal breathers up to 6 weeks of life as they tend to have a larynx with a high position in the neck from the second to third cervical vertebrae 2 .…”