Complications of Endoscopic Surgery of Congenital Choanal Atresia: How to Avoid It?

Abstract

Background: Choanal atresia is developmental failure of nasal cavity to communicate with nasopharynx causing complete obstruction of the nasal cavity. Objective: This study was aimed to review the trans-nasal endoscopic approach systematically as a minimally invasive surgery to treat unilateral or bilateral choanal atresia, to analyze the complications of this procedure and how to avoid it. Patients and Methods: This retrospective study included twenty-five patients, with congenital choanal Atresia (CCA) who underwent primary transnasal endoscopic repair. The data was collected from patients records at Zagazig University Hospital. Results:The common complication in the study was restenosis, bilateral choanal atresia (BCA) cases were operated at an early age had high rate of recurrence while unilateral choanal atresia (UCA) case has a lower recurrence rate. The current study showed statistically significant relation between restenosis post endoscopy surgery of CCA and age at time of operation, site of atresia, except cases operated using surgical technique iii that started with vomer resection and technique vii with preservation of mucosa using fibrin glue. It noticeable that restenosis commonly occurred among young age exposed to endoscopic surgery and who had bilateral stenosis. Surgical bony resection is usually limited in cases of BCA because both pterygoid processes are medialized and the obtained choana is therefore narrower, whereas, by definition, one pterygoid processes is in normal position in UCA and is covered by a perfect mucosa lining. Conclusions: It could be concluded that the endoscopic transnasal approach is an effective, safe and minimal invasive surgery to treat unilateral or bilateral CCA. Starting with vomer resection give good result regarding patency of neochoana with low complications rate compared with other endoscopic techniques.