Transseptal Repair of Unilateral Choanal Atresia

Abstract

\s=b\Unilateral choanal atresia is a congenital problem initially observed by the otolaryngologist as unilateral nasal obstruction. Elective surgical correction can be done using the transnasal, transpalatal, transantral, or transseptal techniques. Two patients underwent this procedure with the transseptal technique. We believe this is a safe, uncomplicated, and reliable technique for the correction of unilateral choanal atresia. (Arch Otolaryngol 1982;108:659-661) Choanal atresia is a congenital obstruction between the nasal cavity and the nasopharyngeal vault. The first recorded case was by Johann Roedere1 in Germany around 1755. Many operative techniques have been devised for the surgical correction of choanal atresia since the first re¬ ported surgical procedure by Emmert2 in 1853, using a curved trocar to punc¬ ture a bony obstruction. Bilateral choanal atresia demands immediate recognition in the newborn and resto¬ ration of the nasal airway as soon as possible. However, unilateral choanal atresia is usually recognized in child¬ hood and requires an elective, safe operative technique with minimal morbidity and predictable long-term results. The relatively widespread use of transseptal surgery of the sphenoid sinus and the pituitary gland through microscopic visualization makes the transseptal repair of unilateral choa¬ nal atresia an attractive operative technique of this procedure; two rep¬ resentative cases are included.

The transnasal flexible laryngoesophagoscope as an adjunct during surgical correction of choanal atresia

“…Current techniques utilise endoscopic visualisation, both transnasal (alongside the surgical instruments) and also transoral (using an angled endoscope to visualise the choana from the nasopharynx whilst the operating instruments are passed transnasally) 1 9 – 13 Others have described the benefit of creating a posterior septal window so the endoscope can be used on one side and the surgical instruments on the other 14 15 …”

Transnasal Endoscopic Surgery of Choanal Atresia Without the Use of Stents

“…The trans‐septal approach can be useful in repairing unilateral atresia in children older than 8 years of age. 17 This approach permits the simultaneous repair of the deviated septum with the choanal atresia, resection of the vomerian posterior, and placement of the mucosal flaps of the raw choanal area to prevent repeat stenosis. 18 The transnasal approach, which is initially performed with the use of a microscope, makes it possible to view the atresic plate.…”

Trans-septal approach to unilateral posterior choanal atresia

“…Carpenter and Neel (1977) have described a trans-septal technique which they recommend for patients over 8 years old. This has been developed further by Hall et al (1982) in a younger patient.…”