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Choanal Atresia Repair

Contributor: Tyler McElwee

Choanal atresia describes the congenital narrowing of the back of the nasal cavity that causes difficulty breathing in neonate. Choanal atresia is often associated with CHARGE, Treacher Collins and Tessier Syndrome. It is a rare condition that occurs in 1:7000 live births, seen in females twice as often as males, and affects bilaterally in roughly 50% of cases.  Bilateral choanal atresia is usually repaired in the newborn period. Unilateral CA repair is often deferred until age 2-3 years. Stent placement has become optional as stentless repair is gaining popularity because this technique decreases foreign body reaction in the nasopharynx which in term decreases granulation formation.  Transnasal endoscopic choanal atresia repair is performed by opening the atresia bilaterally, drilling out pterygoid bone as needed, and removal of the posterior septum and vomer. Normal mucosa is preserved as much as possible by elevating a lateral based mucosal flap to prevent scarring and restenosis. Postoperatively, these patients are treated with antibiotic, reflux medications and steroid nasal drops; a second look procedure is planned 4-6 weeks postop for debridement and possible removal of granulation tissue & scar.

DOI: http://dx.doi.org/10.17797/9s5ty2f7yv

Editor Recruited By: Sanjay Parikh, MD, FACS

Bilateral choanal atresia repair
Patient with bilateral choanal atresia
N/A
ESS setup; Otologic microdissection instruments
CT scan of fine cuts through base of skull
Laterally based mucosa flap should be raised and preserved if possible to decrease granulation tissue & scarring. Posterior septum and vomer should be removed using a combination of back biter and microdebrider.
N/A
Bleeding, infection & re-stenosis
Bleeding, infection & re-stenosis
N/A
N/A

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