Revision choanal atresia repair

Since the first description of choanal atresia (CA) in 1755, multiple surgical techniques have been proposed to repair the malformation. Today, the transnasal endoscopic method is the most widely accepted repair technique. The bony choanal plates are perforated, the lateral choanae are drilled, and a portion of the vomer removed. Unfortunately, the problem of re-stenosis is a significant issue, and as a result, revision surgery may be a recurring theme in some children. We describe a successful revision endoscopic technique utilizing a microdebrider with straight and 120 degrees telescopes, image guided surgery, and topical mitomycin-C to permanently open the choanae without stenting.

Described are six children (1-15 years old) with CA or stenosis who have collectively undergone 25 choanal procedures at various institutions. A microdebrider carefully removes the bony septum under direct nasal and intraoral telescopic visualization. No lateral drilling is performed. Image guidance is helpful when excessive scar tissue is present. Topical mitomycin-C minimizes post-operative scarring. The cartilaginous septum is left intact.

2-4-year clinical and endoscopic follow-up on all children revealed a widely patent nasal airway with no complications (epistaxis, crusting, or re-stenosis). Synechiae or re-stenosis did not occur as circumferential mucosal stripping was avoided. No stenting was needed since the bony septum is removed.

Near total endoscopic removal of the bony septum provides long-term nasal patency for revision CA/stenosis repairs. The endoscopic 'common choanae' technique is aided by transnasal and transoral telescopic visualization with precise microdebrider removal of the bony septum. The technique is safe with no complications in our case series.