A Transpalatine Operation for Congenital Atresia of the Choanae in the Small Child or the Infant

Abstract

Congenital atresia of the choanae is being more frequently recognized, and in time, with members of the medical profession more informed, it is likely that this condition will be discovered earlier and earlier in life. While operations for its relief have been increasingly successful in adults and older children, they have been less successful in small children and in infants. In an attempt to improve the results in these young patients, a transpalatine approach was tried with success in a 3 year old child. Because of the rarity of this congenital anomaly and the remote possibility of presenting a series of personal cases, this single case is reported. It is fully realized that the outcome in this particular instance may have been a fortunate one. However, it is hoped that this presentation may encourage other surgeons to test the merit of the operation. TREATMENT The usual textbooks offer little or nothing on the subject under discussion, and on turning to the periodical literature one is confused by the variety of corrective procedures presented. These operations, however, can be conveniently grouped as those in which the atretic wall has been removed by the following approaches :1. Surgical removal of the obstruction by direct approach through the nares. One or more instruments, such as trocars, burrs, chisels, drills, trephines, punches and curets, have been used on the obstructing wall. The removal of the posterior end of the vomer has been an impor¬ tant additional procedure in the opinion of many surgeons. Rubber tubes, bougies, packing, metal splints and skin grafts have also been used to keep the passage open. These methods have been used with some success in the treatment of patients of all ages.2. Cautery removal by direct approach through the nares. This approach could be considered under the heading of direct surgical removal, but it has been mentioned separately because of its very different method and because it has usually been employed in adults. . At times, it has been used secondary to direct surgical removal. It includes use of chemicals, galvanocautery and surgical diathermy.3. Removal after primary submucous resec¬ tion of the nasal septum. The posterior end of the entire septum has been removed by some operators, and others have made an opening through the posterior portion of the septumwith or without removal of the occluding dia¬ phragm in patients with unilateral occlusion. These approaches have been successfully applied in adults and older children. 4. Removal by an oral approach through the palate. This will be discussed later. REPORT OF A CASEJ. C, a girl 3 years of age, was seen at my office on April 20, 1943. She complained that the left side of her nose stopped up easily, that she could not blow through it and that clear mucus ran out, particularly when she leaned over. This nasal disorder had been present since birth, but medical attention had not been sought as the parents thought the condition would dis¬ appear spontaneously. The child's general health had been good.Examinati...

Klinische Manifestationen der CHARGE-Assoziation im Mund-, Kiefer- und Gesichtsbereich

“…Auf Schweckendiek [24] geht eine doppeltürflügelartige Schnittführung zurück. Ruddy [23] wählte eine bogenförmige Inzision an der Hinterkante des Hartgaumens. Ruddy [23] wählte eine bogenförmige Inzision an der Hinterkante des Hartgaumens.…”

“…5 a-f. Schnittführungen beim transpalatinalen Zugang, a alveolarkammnahe Inzision [27], b Modifikation mit Aussparung der Papilla incisiva [17], c zentrale, bogenförmige Inzision [1], d Ypsilonschnitt [31], e doppeltürflügelartiger Schnitt [24], f dorsaler Bogenschnitt [23] [20]. 5 a-f. Schnittführungen beim transpalatinalen Zugang, a alveolarkammnahe Inzision [27], b Modifikation mit Aussparung der Papilla incisiva [17], c zentrale, bogenförmige Inzision [1], d Ypsilonschnitt [31], e doppeltürflügelartiger Schnitt [24], f dorsaler Bogenschnitt [23] [20].…”

Surgical Management of Congenital Choanal Atresia

“…In America, Ruddy,11 in 1945, and Owens,12 in 1951, called attention to the advantages of the transpalatine route to the posterior nares, and emphasized its usefulness in infants and young children as well as adults. This approach has significant advantages.…”

Transnasal correction of choanal atresia

“…Note the imperforate naris, nasobuccal membrane, and oropharyngeal membrane. (6) Gradual resolution of the external naris and oropharyngeal membrane, The ,primitive choana is already patent. (C) The definitive palate is dividing the nasopharynx from the oropharynx.…”

“…Note that the midportion of the tube is slightly curved to suit the convexity of the hard palate in the nasal floor. The polyethylene tubing can be molded by gently heating it by match or alcohol lamp (6). Polyethylene tubing used for unilateral choanal atresia.…”