Stentless mirrored L-shaped septonasal flap versus stented flapless technique for endoscopic endonasal repair of bilateral congenital choanal atresia: a prospective randomised controlled study

Tomoum, Mohamed Osama; Askar, Mohamed; Mandour, Mahmoud; Amer, Mohamed; Saafan, Magdy Eisa

doi:10.1017/s0022215117002614

Cited by 16 publications

(9 citation statements)

References 29 publications

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“…For the purpose of preventing restenosis and subsequent reoperation, many authors advocate preserving the mucosa for use as flaps. From a 1990 report describing an initial pharyngeal mucosa flap with a star-shaped incision, variously designed shapes of mucosal flaps have been published, including the swinging door flap, mirrored L-shaped septonasal flap, nasal septal cross-over flap, and folded-over-flap [ 3 , 8 , 15 , 23 ]. However, adopting the same mucosal flap design for different atretic types is impractical because of the limitations of each technique.…”

Section: Discussionmentioning

confidence: 99%

“…A vertical incision was made from top to bottom at the cartilaginous/bony junction through the septal mucosa approximately 5–10 mm anterior to the atretic plate (the inferior aspect of the middle turbinate was used as a landmark for the superior limit of dissection, that can reduce the risk if cutting near or through the posterior septal artery), following to the floor of the nasal cavity, reaching the lateral wall of the nasal cavity (hence the name “L-shaped”) [ 3 ]. The mucosal flap over the thickened vomer and the nasal face of the atretic plate was elevated carefully to achieve maximal preservation of the mucosa and harvested flap.…”

Section: Methodsmentioning

confidence: 99%

“…The nature of the obstructing atretic plate has been described as 90% bony and 10% membranous in earlier studies. However, more recent studies have revealed that 30% of such malformations consist of a purely bony obstruction and 70% are a mixed bony-membranous obstruction [ 3 ]. Neonates are obligate nasal breathers, and bilateral CCA becomes apparent with the occurrence of acute respiratory distress and cyanosis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: A retrospective study

Wang

Tang

Zhang

et al. 2021

Journal of Otolaryngology - Head & Neck Surgery

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Background Multiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and evaluate outcomes of the endoscopic septonasal flap technique combined with bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants. Methods Clinical data of 37 neonates and infants with congenital choanal atresia who received nasal endoscopic surgery with the flap technique between January 2018 and July 2020 were analyzed retrospectively. All patients underwent the ultra‑low‑dose paranasal sinus computed tomography imaging preoperatively to confirm diagnosis and plan the surgery. In these patients, the mirrored L-shaped flap technique was performed for bilateral atresia and the cross-over L-shaped flap technique was performed for unilateral atresia. A total of 22 patients had silicone stents postoperatively and 15 patients had bioabsorbable steroid-eluting stents postoperatively. Silicone stents were removed at one month postoperatively under secondary general anesthesia, while no anesthesia was needed to remove the bioabsorbable steroid-eluting stents. Postoperative follow-up ranged from 10 months to 3 years. Results The septonasal flap technique was performed in all patients. Compared with the silicone stents group, the average operative duration and the hospital length of stay in the bioabsorbable steroid-eluting stents group were decreased [(97.46 ± 15.37) min vs (83.49 ± 19.16) min t = 13.733, P < 0.001] [(12.8 ± 3.22) d vs (7.67 ± 3.91) d t = 15.082, P < 0.001], the average number of procedures was reduced [(2.04 ± 0.64) vs (1.00 ± 0.001), t = 82.689, P < 0.001], the differences were statistically significant. There were no reports of postoperative restenosis and complications in the bioabsorbable steroid-eluting stents group, and follow-up endoscopic examinations showed patency and stable nasal passages in all cases. Conclusions The endoscopic septonasal flap technique can effectively expose and expand the choanal bony structure for repair of congenital choanal atresia in neonates and infants. The combined use of this technique along with bioabsorbable steroid-eluting stents can help prevent the need for revision procedures and also against stent-related injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: A retrospective study

Wang

Tang

Zhang

et al. 2021

Journal of Otolaryngology - Head & Neck Surgery

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“…No significant differences in surgical outcomes were seen with or without the use of stents, as the rate of restenosis was 42.9% with stent and 47.4% without a stent. Tomoum et al [27] reported a comparative evaluation of the endoscopic repair of CA in 72 newborns using a mirrored L-shaped flap without stenting versus stenting without a flap. Patient follow-up revealed higher granulation tissue in patients with a stent (53.3%) than without (28.6%) and 33.33% stenosis in patients with stent and 21.40% in patients without a stent.…”

Section: Reviewmentioning

confidence: 99%

Choanal Atresia Repair in Pediatric Patients: Is the Use of Stents Recommended?

Albdah¹,

Alanbari

Alwadi

2019

Cureus

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Choanal atresia, the obliteration or narrowing of nasal choana, is widely studied across the pediatric and adult population. While unilateral choanal atresia can remain unidentified for several years, bilateral choanal atresia requires immediate intervention, as children are primarily nasal breathers until the initial four months of age. Several surgical methods are reported for repairing choanal atresia in children, and the choice of postoperative management with or without stents is still controversial. In this review, we analyzed several recent studies in which surgery for choanal atresia repair was followed by stent-assisted and/or stentless management. The results of this study are likely to pave the way for a further understanding of the choice of method to increase patency and reduce possible complications.

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“…The operation for patients with unilateral CA might be delayed until school age. 2,3 In the literature, the disease has been evaluated in terms of etiopathogenesis, 4 surgical treatment approaches, 5,6 and accompanying diseases. 7 However, few articles have evaluated anesthesia management of patients with special features like CA.…”

mentioning

confidence: 99%

Anesthesia management in patients with choanal atresia

Boran

Sarıca

2019

Baylor University Medical Center Proceedings

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In this retrospective study, we reviewed the anesthesia management of patients with choanal atresia (CA). Fourteen patients undergoing surgery for CA between June 2007 and September 2018 were evaluated for age, gender, CA side, complications, American Society of Anesthesiologists score, duration of anesthesia, and presence of any additional anomalies. Six patients (42%) had bilateral atresia, and 8 (58%) had unilateral atresia. Various congenital anomalies were present in 50% of patients with bilateral atresia. Three patients were intubated with a C-MAC D pediatric blade because their Cormack-Lehane grade was 3 or 4. Though sevoflurane was used for all patients, total intravenous anesthesia was used for two patients with unilateral atresia. All patients were followed postoperatively while intubated except one patient with bilateral atresia. There was no need for postoperative intubation of any patients with unilateral atresia. In conclusion, clinicians should be aware of perioperative and postoperative complications in patients with CA, bilateral atresia, and accompanying congenital anomalies in the neonatal period. Total intravenous anesthesia can be chosen instead of inhalation anesthesia in appropriate cases, but sevoflurane can be used safely in the induction of anesthesia.

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Stentless mirrored L-shaped septonasal flap versus stented flapless technique for endoscopic endonasal repair of bilateral congenital choanal atresia: a prospective randomised controlled study

Abstract: The endoscopic approach utilising a flap without stenting is safe and effective, with a high success rate.

Cited by 16 publications

References 29 publications

Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: A retrospective study

Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: A retrospective study

Choanal Atresia Repair in Pediatric Patients: Is the Use of Stents Recommended?

Anesthesia management in patients with choanal atresia

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