Surgery for congenital choanal atresia

Cedin, Antonio Carlos; Atallah, Álvaro Nagib; Andriolo, Régis B; Cruz, Oswaldo Laércio Mendonça; Pignatari, Shirley

doi:10.1002/14651858.cd008993.pub2

Cited by 45 publications

(41 citation statements)

References 57 publications

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“…1 Choanal atresia and stenosis are the most common craniofacial abnormalities of the nose and often require multiple corrective surgeries or can lead to life-threatening airway obstruction. 2, 3 In spite of its clinical significance, the etiology of choanal atresia or stenosis in the absence of a chromosome abnormality or malformation syndrome or sequence is not well understood in humans. 4 …”

Section: Introductionmentioning

confidence: 99%

Maternal Residential Atrazine Exposure and Risk for Choanal Atresia and Stenosis in Offspring

Agopian

Cai

Langlois

et al. 2013

The Journal of Pediatrics

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Objective To assess the relationship between estimated residential maternal exposure to atrazine during pregnancy and risk for choanal atresia or stenosis in offspring. Study Design Data for 280 nonsyndromic cases and randomly selected, population-based controls delivered during 1999 to 2008 were obtained from the Texas Birth Defects Registry. County-level estimates of atrazine levels obtained from the United States Geological Survey were assigned to cases and controls based on maternal county of residence at delivery. Unconditional logistic regression was used to assess the relationship between maternal residential atrazine exposure and risk for choanal atresia or stenosis in offspring. Results Compared to offspring of mothers with low levels of estimated residential atrazine exposure, those with high levels had nearly a two-fold increase in risk for choanal atresia or stenosis (adjusted odds ratio: 1.79, 95% confidence interval: 1.17–2.74). A significant linear trend was also observed with increasing levels of atrazine exposure (adjusted P = 0.002). Conclusions A link between maternal exposure to endocrine disruptors, such as atrazine, and choanal atresia risk is plausible based on previous findings. Our results further support this hypothesis.

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Section: Introductionmentioning

confidence: 99%

Maternal Residential Atrazine Exposure and Risk for Choanal Atresia and Stenosis in Offspring

Agopian

Cai

Langlois

et al. 2013

The Journal of Pediatrics

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“…There were no stents used in the procedure nor was there any use of mitomycin C (MMC), a compound which has been suggested to be useful in the past in minimising restenosis of CA repair 12. Traditional methods and teaching in CA repair suggest that postoperative measures should include placements of stenting devices in order to decrease the chances of restenosis, however, in their recent review of CA repair, Cedin et al 12 found no significant differences between repair methods nor use of MMC with regard to rates of restenosis nor with regard to total number of procedures 12. In the review it was noted that between four and six total procedures per patient was typically required in order to achieve complete repair with no restenosis 12.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional methods and teaching in CA repair suggest that postoperative measures should include placements of stenting devices in order to decrease the chances of restenosis, however, in their recent review of CA repair, Cedin et al 12 found no significant differences between repair methods nor use of MMC with regard to rates of restenosis nor with regard to total number of procedures 12. In the review it was noted that between four and six total procedures per patient was typically required in order to achieve complete repair with no restenosis 12. Our case, using a combined oronasal endoscopic approach with no stenting or adjuvant medications has to date undergone a total of four procedures including the initial repair, in keeping with the expected numbers of required procedures as reported in previous literature.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of bilateral choanal atresia? Bilateral choanal atresia diagnosed in a 5-year-old girl

2014

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Choanal atresia (CA) is an obliteration or blockage of the posterior nasal aperture, limiting or obstructing the nasal airway to the nasopharynx. The presentation of unilateral CA commonly occurs at a later age than those children affected by bilateral CA (BCA) and can often persist undiagnosed into adulthood. BCA, on the other hand, typically presents with respiratory obstruction within the first few days of life, or desaturations with or without cyanosis when feeding or during exertion and traditional teaching is that this is a life-threatening emergency. We present the case of a 5-year-old girl referred to our department with nasal obstruction, snoring and some mild rhinorrhoea. After investigation she was found to have a mixed bony and membranous BCA and no other craniofacial abnormalities. The BCA was subsequently repaired using urethral dilators and a drill and the child is currently asymptomatic of any restenosis. This case prompts discussion of the various presentations and options in management of CA as well as allowing us an opportunity to discuss the literature on the subject.

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“…On review of the literature, it appears that the lack of standardized outcome measures regarding the definition of choanal restenosis, of revision surgery and of follow-up time, which should include values for both average and range, makes interpretation of results of different surgical techniques difficult [1,5,52]. Furthermore, some reports are based on single surgeon experience and others on institutional series.…”

Section: Accepted Manuscriptmentioning

confidence: 99%