Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article

Abstract

Background Choanal Atresia is an obliteration by an atretic plate of the posterior choanae due to a failure of the bucconasal membrane to rupture. The insertion of stents post choanal atresia repair is familiar. Still, there are limited studies in the literature that specify the time to remove it, the best materials, and the effectiveness of each kind. Objective Our study aims to compare different types of choanal atresia stents and flaps and the outcome of different kinds of stents and flaps that use post-operatively. Also, to assess the risk of restenosis post-operatively with varying types of Stent and flaps. Methods A systematic review via databases for different types of stents and flaps used in choanal atresia, including 31 studies with precise technique, variety of stents, restenosis rates, and risk factors (unilaterality, the component of the atretic plate). And about 10 different approaches to flaps reconstruction were mentioned. Results According to the data, we observed a successful rate of choanal atresia repair by using the ordinary ETT post-operatively ranged from 28 to 94.2%, which could be explained due to many factors. Post-operative Instructions on care and suctioning provided a good impact. Other types of stents found in case series like steroid eluting stents, Nelaton catheters, Silastic stents, or modified ETT have a promising future during 26 to 39 weeks follow-up. Still, they need further studies with randomization and more data. Flaps with different approaches and techniques showed promising results and fewer complication rates with or without stents, also now have been used in practice providing suitable alternatives for stents. Conclusion The original types of choanal atresia stents were shown to have a wide variety of results, while innovative materials of stents showed promising results, however, in relatively small case studies. Flaps were now used in practice giving other choices for stents with fewer complications, better healing, and new choana formation.

Pädiatrische Rhinologie

“…The authors of the paper prefer the use of a narrow diamond drill with reduced speed (10,000 rpm). If possible, the mucosa should be preserved as a pedicled flap that is then replaced on the exposed bony walls of the neochoans at the end of the procedure to accelerate epithelialization of the wound surfaces and thus prevent re-stenosis [23]. The success rate of transnasal endoscopic choanalplasty, as measured by the occurrence of re-stenosis or the need for revision surgery, was 65 % in a meta-analysis by Strychowsky et al [24].…”

“…Die Autoren des Referates bevorzugen den Einsatz eines schmalen Diamantbohrers unter Verwendung einer reduzierten Umdrehungszahl (10.000 Umdrehungen/min). Die Schleimhaut sollte -falls möglich -als gestielter Lappen erhalten werden, der am Ende des Eingriffs auf die freiliegenden knöchernen Wände der Neochoane gelegt wird, um eine Epithelisierung der Wundflächen zu beschleunigen und damit eine Re-Stenose zu verhindern [23]. Die Erfolgsrate der transnasal endoskopischen Choanalplastik, gemessen am Auftreten einer Re-Stenose oder der Notwendigkeit einer Revisionsoperation, beträgt in einer Metaanalyse von Strychowsky et al 65 % [24].…”

Klinisches Management der Choanalatresie

“…Über die Variation der Schnittfüh-rung kann eine zirkumferenzielle Deckung der anliegenden Knochen, des medialen Pterygoids und inferioren Sphenoids oder des freiliegenden Vomers erfolgen [11,13,15,37]. Die Anlage eines Schleimhautlappens mit gespiegelter L-förmiger Schnittführung zeigt sich in der Versorgung der bCA (n = 42) in einer 2018 [41,42,43].…”