Transnasal Treatment of Congenital Choanal Atresia with the KTP Laser

Abstract

This retrospective analysis presents a minimally invasive method for a transnasal approach to treat bilateral and unilateral choanal atresia and stenosis in infants and children. We describe an advanced surgical technique that applies the use of a KTP laser and give recommendations for preoperative diagnosis and postoperative assessment. We report 13 cases of bilateral and unilateral choanal atresia or stenosis treated over a 3 1/2-year period. We used a transnasal approach and endoscopic control. For bilateral choanal atresia, the operation was performed within the first few days of birth. For unilateral choanal atresia or stenosis, surgery was performed several weeks after birth. In all cases, an intranasal stent was inserted. Our findings demonstrate that this transnasal approach provides significant benefits. A primary advantage is the diminished risk of intraoperative or postoperative complications. Additional benefits include lower rates of re-obstruction and a decreased incidence of subsequent disease, including chronic secretory otitis media.

An update on choanal atresia surgery at Great Ormond Street Hospital for Children: preliminary results with Mitomycin C and the KTP laser

“…We would hesitate to infer that the laser is causing the poor outcomes, however, but rather that the use of the laser is more likely in children with difficult problems who have already had a number of unsuccessful procedures. This is the first study to attempt to compare outcomes after use of the KTP laser, with previous reports being limited to small series [9,10].…”

“…It has been shown that the results after transnasal surgery are comparable to those after transpalatal surgery [1], although the latter is associated with greater blood loss, longer operating time and a more prolonged recovery [2]. For the choice of surgical instruments there are no comparative data, and drills [3][4][5], microdebriders [6][7][8] and lasers [9,10] all have their advocates.…”

Stenting for bilateral congenital choanal atresia—A new technique

“…CCA may present as part of a nonrandom association of congenital malformations grouped together as CHARGE association (coloboma, heart disease, atresia, retarded growth, genital hypoplasia and ear anomalies) [2,3,4] with a reported incidence of 1:10,000 births.…”

“…Previous transpalatal or transmaxillary approaches to the nasal choana have largely been dispensed with in favour of endonasal approaches. Perforation of the atretic plate has been described with use of trocars, chisels, drills, microdebriders and lasers, with or without assistance of endoscopes [3,[5][6][7]. A characteristic of surgery for CCA is the frequent recurrence of stenosis with the consequent need for multiple dilatations under general anaesthesia.…”

“…There is no uniformity of opinion as to the efficacy of one type of stent or method of surgery above another. The use of mitomycin (an antiproliferative and antitumour aminoglycoside antibiotic used intra-operatively to prevent scar tissue and granulation formation post surgery [3,5]) as an adjunct to CCA surgery has still to be established as beneficial.…”