Disclaimer: The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature. Choanal Atresia Congenital posterior choanal atresia is an uncommon anomaly which can have life-threatening consequences. The first recorded description of this disorder was by Otto in 1830. The first attempted repair was by Carl Emmert in 1851. The first recorded successful repair on an infant was in 1872 by Jacob Da Silva Solis-Cohen. The transpalatal approach was first described by Brunk in 1909. The reported incidence of choanal atresia is one in 5,000 to 8,000 live births. Unilateral cases outnumber bilateral cases by two to one. The female to male ratio is also 2-to-1. Clinical presentation of bilateral choanal atresia includes severe feeding difficulties and airway obstruction. The diagnosis is usually made by inability to pass a suction catheter transnasally. The diagnosis is confirmed by CT scanning which accurately defines the anatomy of the atresia. Temporary control of the airway can be achieved by endotracheal intubation or the use of the McGovern nipple. The current literature was reviewed which reveals an ongoing controversy as to the optimal surgical approach. The main approaches are transnasal or transpalatal and each has its adherents. Other controversies include the timing of surgery, and the method and duration of stenting. A review of other series of patients reveals no clear advantage of one surgical approach over another. A retrospective of all cases of choanal atresia treated at TCH from 1981 to 1991 was presented. Ten patients were identified. A variety of investigations and surgical approaches were undertaken. Unfortunately the numbers were too small, and the follow-up too inconsistent, to draw any conclusions. Case Presentation A 6-year-old boy presented with a history of chronic right nasal congestion. At age 3 he had been diagnosed elsewhere as having unilateral choanal atresia which was not repaired. CT scanning performed elsewhere revealed right unilateral bony choanal atresia. The patient's medical history was otherwise unremarkable and he had no associated congenital anomalies. The patient underwent transpalatal repair with placement of a 5.5 endotracheal tube stent. At six-week follow-up he was found to have some granulation tissue and the stent was reinserted in the operating room. The stent was removed three weeks later. At three-month follow-up the patient was noted to have a good nasal airway bilaterally. Bibliography Bartal N. An improved stent for use in the surgical management of congenital posterior choanal atresia. J Laryngol Otol 1988;102:146-147. Benjamin B. Evaluation of choanal atresia. Ann Otol Rhinol Laryngol 1985;94:429-432. Bergstrom L, Owens O. Posterior choanal atresia: a syndromal disorder. Laryngoscope 1984;94:1273-1276. Birck HG, Parrish RT. The movable stent in choanal atresia. Laryngoscope 1986;96:135-139. Brown OE, Burns DK, Smith TH, Rutledge JC. Bilateral posterior choanal atresia: a morphologic and histologic study, and computed tomographic correlation. Internatl J Pediatr Otorhinolaryngol 1987;13:125-142. Crockett DM, Healy GB, McGill TJ, Friedman EM. Computed tomography in the evaluation of choanal atresia in infants and children. Laryngoscope 1987;97:174-183. Dehaen F, Clement PAR. Endonasal surgical treatment of bilateral choanal atresia under optic control in the infant. J Otolaryngol 1985;14:95-98. Duncan NO 3d, Miller RH, Catlin FI. Choanal atresia and associated anomalies: the CHARGE association. Internatl J Pediatr Otorhinolaryngol 1988;15:129-135. El-Guindy A, El-Sherief S, Hagrass H, Gamea A. Endoscopic endonasal surgery of posterior choanal atresia. J Laryngol Otol 1992;106:528-529. Fearon B, Dickson J. Bilateral choanal atresia in the newborn: plan of action. Laryngoscope 1968;78:1487-1499. Ferguson JL, Neel HB 3d. Choanal atresia: treatment trends on 47 patients over 33 years. Ann Otol Rhinol Laryngol 1989;98:110-112. Feuerstein SS, Krespi YP, Sachdev RK. Transnasal correction of choanal atresia. Head Neck Surg 1980;3:97-104. Freng A. Surgical treatment of congenital choanal atresia. Ann Otol 1978;87:346-350. Grundfast KM, Thomsen JR, Barber CS. An improved stent method for choanal atresia repair. Laryngoscope 1990;100:1132-1136. Harner SG, McDonald TJ, Reese DF. The anatomy of congenital choanal atresia. Otolaryngol Head Neck Surg 1981;89:7-9. Healy GB, McGill T, Jako GJ, Strong MS, Vaughan CW. Management of choanal atresia with the carbon dioxide laser. Ann Otol 1978;87:658-662. Hengerer AS, Strome M. Choanal atresia: a new embryologic theory and its influence on surgical management. Laryngoscope 1982;92:913-921. Kaplan LC. The CHARGE association: choanal atresia and multiple congenital anomalies. Otolaryngol Clin North AM 1989;22:661-672. Kearns DB, Wickstead M, Choa DI, Leitch RN, Bailey CM, Evans JNG. Computed tomography in choanal atresia. J Laryngol Otol 1099;102:414-418. Koltai PJ. The external rhinoplasty for the correction of unilateral choanal atresia in young children. Ear Nose Throat J 1991;70:450-453. Krespi JP, Husain S, Levine TM, Reede DL. Sublabial transseptal repair of choanal atresia or stenosis. Laryngoscope 1987;97:1402-1406. Maniglia AJ, Goodwin WJ Jr. Congenital choanal atresia. Otolaryngol Clin North AM 1981;14:167-173. McIntosh WA. Trans-septal approach to unilateral posterior choanal atresia. J Laryngol Otol 1986;110:1133-1137. Morgan DW, Bailey CM. Current management of choanal atresia. Internal J Pediatr Otorhinolaryngol 1990;19:1-13. Muntz HR. Pitfalls to laser correction of choanal atresia. Ann Otol Rhinol Laryngol 1987;96:43-46. Pirsig W. Surgery of choanal atresia in infants and children: historical notes and updated review. Internatl J Pediatr Otorhinolaryngol 1986;11:153-170. Prescott CAJ. Experience with bilateral congenital atresia of the posterior nasal choanae. J Laryngol Otol 1986;100:1255-1261. Resouly A, Barnard JDW, Purnell AN. Access of Le Fort I osteotomy for correction of unilateral choanal atresia. Clin Otolaryngol 1990;15:281-282. Richardson MA, Osguthorpe JD. Surgical management of choanal atresia. Laryngoscope 1988;98:915-918. Schwartz ML, Savetsky L. Choanal atresia: clinical features, surgical approach, and long-term follow-up. Laryngoscope 1986;96:1335-1339. Sculerati N, Stool SE. A long-term, indwelling stent for maintenance of nasal patency in choanal atresia. Laryngoscope 1988;98:679-680. Singh B. A safer transnasal technique for the management of bilateral choanal atresia. J Laryngol Otol 1991;105:1004-1005. Stankiewicz JA. The endoscopic repair of choanal atresia. Otolaryngol Head Neck Surg 1990;103:931-937. Wolach B, Weinberg J. A simple transnasal procedure for treating choanal atresia. Internatl J Pediatr Otorhinolaryngol 1990;19:185-188. Grand Rounds Archive | Department Home page BCM Public | BCM Intranet | Privacy Notices | Contact BCM | BCM Site Map | ©2001-2006 Baylor College of Medicine
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