Endonasal choanal atresia repair; evaluating the surgical results of 58 cases

Abstract

Background. Choanal atresia is the most common congenital nasal anomaly, with an incidence of 1:5000-1:8000 live births. Atresia can be seen as membraneous, bony or mixed type. When it is bilateral, it is accepted lifethreatening, therefore bilateral atresia necessitates immediate intervention. Diagnosis is confirmed by endoscopic examination and computed tomography. The absolute treatment is surgical, and different approaches have been proposed. Methods. Herein, we describe our 15-year experience in the treatment of 58 patients of congenital choanal atresia with transnasal endoscopic approach, and we compare the efficacy of placement of an intranasal stent and applying mitomycin while endoscopic microsurgical repair. Results. The study included 41 female patients (71%) and 17 male patients (29%) with congenital CA. The mean age was 3 years ranging from 10 days to 16 years. The atretic plate was bilateral in 24 patients (41%) and unilateral in 34 (59%). The most common atresia type was the mixed type with 29 patients (50%). A total of 17 patients (29%) required postoperative revision(s). Postoperative revisions were more frequent among patients with bilateral CA (50%), and with mixed CA (31%). Stenting was used additionally by surgical correction for 10 patients. After stenting, fibrosis and restenosis was seen in 7 patients (79%). Mitomycin C was applied peroperatively in 8 patients. Restenosis after mitomycin application was seen in 4 patients (50%). Conclusions. By our experience, endoscopic microsurgical repair of atresia proved to be an effective and safe procedure, results compared with adjuvant treatment modalities like stent or mitomycin C use, was not better. Restenosis was the major problem seen after surgical correction.

Choanal atresia repair in Germany

“…Die Technik der dorsalen Septumresektion hat sich über die letzten 30 Jahre zunehmend als grundlegende chirurgische Technik durchgesetzt [ 5 , 9 , 14 , 21 ]. Die Verwendung von Stents dagegen, welche initial standardmäßig postoperativ verwendet wurden, wird aufgrund zahlreicher Komplikationen und dem erhöhten Rezidivrisiko, welches die Stents mit sich bringen, zunehmend kontrovers diskutiert [ 1 – 3 , 5 , 7 , 11 , 12 , 22 ]. Strychowsky et al.…”

Endoscopic Endonasal Repair of Congenital Choanal Atresia: Predictive Factors of Surgical Stability and Healing Outcomes

“…is characterized by persistent nasal discharge with chronic, foul-smelling, and unilateral rhinorrhea, with a consequently delayed diagnosis in adulthood [ 5 , 6 , 7 , 8 ]. The primary objectives of surgical treatment are to create as soon as possible a stable and adequate neochoanal orifice for regular breathing, to re-establish regular feeding for the child, and to reduce the postoperative hospital stay [ 9 , 10 , 11 ]. Although various surgical approaches have been suggested for treating C.C.A., such as the transnasal, the sublabial-transnasal, the transpalatine, or the transseptal approaches, nowadays, most C.C.A.s are operated on endoscopically.…”