Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis

Abstract

The surgical technique described follows the basic requirements of corrective surgery and allows good visualization, evaluation and treatment of the atretic plate and the posterior third of the septum, in order to create the new choanal opening. We believe that the use of a stent is not necessary, as recommended in case of other surgical techniques involving the use of more mucosal flaps.

Comprehensive management of congenital choanal atresia

“…Stents were reported to induce complications: major granulation tissue formation, intranasal inflammation and infection, excoriation or erosion of the nares, columellar necrosis, septal injuries or perforation, premature extrusion, dislodgement, stent blockage, discomfort and pain [ (53,58,70,72,74,75]. Prolonged mucosal trauma around stents stimulates scar tissue formation, especially circumferential scar, thereby increasing the risk of restenosis [35,55,57]. By avoiding stenting, the authors never encountered such complications.…”

“…Despite the lack of standardization of the outcome measures of the series included, a certain number of surgical guidelines can be put forward that appear to reduce the risk of a restenosis. They are: to enlarge as much as possible the unineochoanae [9,25,34,[54][55][56][57], to use mucosal flaps to cover all raw surfaces [25,54,55,[57][58][59], to secure them with fibrin glue [35,55], and to avoid stenting. Addressing these rules helped the authors to achieve functionally patent choanae with one surgery in 96% of the patients.…”

Transoral approach for choanal atresia repair: a new surgical innovation in the making

“…This approach " Transnasal" became more popular and almost replaced the transpalatal approach. 2,4 Recurrence of choanal atresia after transnasal approach is more common (30-40%) than the old transpalatal approach but due to fewer complications, surgeons have stuck with the least invasive technique. 4,5 Recurrence has been shown to be more common if the endoscopic procedure was done in the neonatal period (first 30 days of life).…”

“…2,4 Recurrence of choanal atresia after transnasal approach is more common (30-40%) than the old transpalatal approach but due to fewer complications, surgeons have stuck with the least invasive technique. 4,5 Recurrence has been shown to be more common if the endoscopic procedure was done in the neonatal period (first 30 days of life). The reason for recurrence is thought to be due to the young age of neonates and possible intrinsic factors that led to the stenosis in the first place playing a role in restenosis.…”

“…Many modifications of the transnasal approach were used to improve the success rate including flap techniques and the use or disuse of nasal stents. 4,8 Others suggested routine resection of the vomer as part of the procedure. 7 These modifications of transnasal approach trying to improve the success rate imply that it is not the perfect approach.…”