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Predictive factors for success after transnasal endoscopic treatment of choanal atresia
Natacha Teissier1, Florentia Kaguelidou, Vincent Couloigner
1Department of Pediatric Otorhinolaryngology, Robert Debré Hospital, 48 bd Sérurier, 75019 Paris, France. natacha.teissier@rdb.aphph.fr
Insights
Transnasal endoscopic repair of choanal atresia (CA) is effective in children. Factors like GERD and young age increase restenosis risk, while surgeon experience improves outcomes.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Endoscopic Surgery
Background:
- Choanal atresia (CA) is a congenital condition causing nasal obstruction in newborns.
- Transnasal endoscopic repair is a common surgical approach for CA.
- Understanding factors influencing surgical outcomes is crucial for improving patient care.
Purpose of the Study:
- To identify factors affecting the success of transnasal endoscopic repair of choanal atresia in children.
- To analyze the impact of patient age, associated malformations, and surgical technique on restenosis rates.
Main Methods:
- Retrospective study of 80 pediatric patients with unilateral or bilateral CA.
- All patients underwent transnasal endoscopic surgery with microdebrider.
- Systematic endoscopic revision and long-term clinical/endoscopic monitoring were performed.
Main Results:
- Age younger than 10 days and gastroesophageal reflux disease (GERD) were associated with increased restenosis.
- Postoperative stenting negatively impacted outcomes.
- Surgeon learning curve positively influenced surgical success; associated anomalies and previous surgery did not significantly affect outcomes.
Conclusions:
- Transnasal endoscopic repair of CA is a safe and successful procedure.
- Early age at surgery and GERD are predictive factors for restenosis.
- Sufficient postoperative endoscopic revision and surgeon experience are key to favorable outcomes.
Objective:
To analyze the different factors affecting the outcome of transnasal endoscopic repair of choanal atresia (CA) in children.
Design:
Retrospective study.
Setting:
Academic tertiary care children's hospital.
Patients:
Eighty patients (48 girls and 32 boys) aged 3 days to 17 years (mean age, 3 years 8 months) who presented with unilateral (n = 53: 37 right, 16 left) or bilateral (n = 27) CA and underwent surgery between September 1996 and December 2005.
Intervention:
All patients underwent transnasal endoscopic surgery with telescopes and a microdebrider. Nasal tubes in neonates and nasal packing in older children were removed after 48 hours. Systematic endoscopic revision was performed under local or general anesthesia a week after surgery. Patients were then clinically and endoscopically monitored for nasal obstruction and healing for a mean follow-up of 43 months.
Results:
A total of 30 patients presented with associated malformations: 9 with CHARGE (coloboma, heart disease, choanal atresia, retardation of postnatal growth()and mental development, genital hypoplasia, and ear anomalies), 1 with Treacher-Collins syndrome, 1 with Kabuki syndrome, 1 with facial cleft, 1 with Down syndrome, 12 with nonsyndromic malformations, and 2 with 22q11 microdeletion. Three children had heart malformations not related to CHARGE association. One child had a congenital nasal piriform aperture stenosis. Twenty-four children had undergone previous surgery; 10 underwent a second procedure with success. Gastroesophageal reflux disease (GERD) was systematically treated in cases of restenosis. Topical mitomycin C was used in 3 patients with relapse. Two patients underwent laser treatment to reduce stenotic scarring. Of the 10 patients who needed revision surgery, 6 had bilateral CA, and 4 had unilateral CA. Age younger than 10 days and presence of GERD increased the chances of restenosis (P = .03). Postoperative stenting negatively affected the outcome. Associated anomalies and previous surgery had no effect on outcome. The bony nature of the CA and bilaterality were not significant (P = .08). However, surgeon learning curve was an important element positively influencing the results (P = .04).
Conclusions:
Transnasal endoscopic repair of CA is a safe and successful technique. Predictive factors of restenosis are the presence of GERD, age younger than 10 days at the time of surgery, and insufficient postoperative endoscopic revision. However, previous surgery and associated malformations are not predictive of a poor surgical outcome.
