Single-Stage Choanal Atresia Repair in the Neonate

Abstract

To evaluate the postoperative results of patients treated with and without the use of stents at the time of initial surgical treatment of choanal atresia (CA). Surgical treatment of CA in the neonatal period is complicated by postoperative stenosis, often necessitating multiple revision surgical procedures.Design: Retrospective medical record review.Setting: Tertiary care academic center.Patients: The medical records of 9 patients treated for bilateral CA during the neonatal period were reviewed. All patients were treated with an endoscopic approach. Outcomes were compared for patients with and without stent use at the initial operation.Main Outcome Measures: Medical records were analyzed for diagnostic modality, clinical symptoms, age at surgery, sex, surgical repair, placement of stents, reoccurrence of atresia, follow-up time, and postoperative outcomes. Results:The mean age at initial surgery was 8 days (range, 5-15 days). Four patients had endotracheal tube stents placed at the time of initial surgery for a duration of 4 to 6 weeks. All patients required at least 1 additional surgery (mean, 2.6 procedures), and 3 (75%) had restenosis during infancy. The mean follow-up time for this group was 7.5 months. Five patients did not have stents placed at the time of initial surgery. None of these patients required additional surgical procedures during infancy, and none developed restenosis. The follow-up time for this group was 2.5 months.Conclusions: This study suggests that the placement of stents for bilateral CA repair during the neonatal period results in a high rate of restenosis as well as the need for multiple subsequent procedures during infancy. The use of an endoscopic approach without stent placement appears to result in superior healing without the need for revision surgery.

A 13-year experience and predictors for success in transnasal endoscopic repair of congenital choanal obliteration

“…However, many predictive factors may affect surgical outcome. These factors include patient age and medical condition at the time of surgery, associated malformations, anatomic nature of the lesion, surgical technique and adjunctive procedures, postoperative stenting, postoperative care, and the surgeon's learning curve [13,18,30,32,33].…”

“…However, there are still many variations in this technique, which are continuously evolving. Commonly accepted practices include simple puncture and dilation [21], KTP laser [22], Ho:YAG laser [23], contact-diode laser [24], use of the microdebrider/drill [25], adjunctive use of mitomycin C [26], mucosal flaps [27,28], and stenting of different types and modifications [29,30]. A review of the literature demonstrates advocates and adversaries for many of these practices.…”

Stentless endoscopic transnasal repair of bilateral choanal atresia starting with resection of vomer

“…Neonates with bilateral choanal atresia need immediate interference for nasal respiratory distress as neonates are obligatory nasal breathers [4].…”

Bilateral Choanal Atresia: Is it Really a Surgical Emergency?

“…In another study mean age at surgery was 8 days [7]. In present study, none of the neonates required intubation and all cases were managed temporarily by orogastric tube/oropharyngeal airway with average age of 10 days at the time of definitive surgery.…”