Endoscopic Repair of Bilateral Congenital Choanal Atresia

Abstract

Careful review of the computed tomography scan and experience with endoscopic nasal surgery makes the transnasal endoscopic treatment a safe and effective approach for managing bilateral choanal atresia.

Management of bilateral choanal atresia in the neonate: an institutional review

“…The results of this paper suggest that careful use of the puncture dilation and stenting technique in the neonatal period can yield success rates in achieving long term nasal patency rates comparable if not better than most transnasal endoscopic techniques (96% versus 66-92%) [1,4,16,17]. However, even the most experienced endoscopist will be challenged by the narrow nasal cavity of the neonate as well as further obstruction caused by septal deviation, turbinate hypertrophy and a high arched palate [8].…”

An update on choanal atresia surgery at Great Ormond Street Hospital for Children: preliminary results with Mitomycin C and the KTP laser

“…It has been shown that the results after transnasal surgery are comparable to those after transpalatal surgery [1], although the latter is associated with greater blood loss, longer operating time and a more prolonged recovery [2]. For the choice of surgical instruments there are no comparative data, and drills [3][4][5], microdebriders [6][7][8] and lasers [9,10] all have their advocates.…”

“…The evidence regarding Mitomycin C (an anti-neoplastic agent which inhibits fibroblasts and angioneogenesis, and therefore reduces granulation tissue formation and subsequent fibrosis) consists of small case series [8,11] and a single small comparative study (not blinded or randomised) which suggests possible benefit [12]. The use of stents is advocated by some [3][4][5]7,[12][13][14], and avoided by others [6,8,15].…”

Single-Stage Choanal Atresia Repair in the Neonate

“…There are 4 current hypotheses to explain the existence of choanal atresia: (1) the persistence of the nasobuccal membrane of Hochstetter, (2) persistence of the foregut buccopharyngeal membrane, (3) abnormal mesodermal adhesions forming in the nasal choanae, and (4) the misdirection of mesodermal flow due to local factors. 3 Others believe that misdirection of the neural crest cells are induced by genetic mutations or environmental factors that cause defects in the palate and nose.…”