[Choanal atresia: personal surgical technique]

Choanal atresia is a rare otorhinolaryngological pathology. It occurs in 1 out of 5,000 children born alive and can be associated with other major or minor congenital abnormalities. The most important associations go under the acronym of C.H.A.R.G.E. (Coloboma, Heart disease, Atresia choanae, Retarded growth and/or development, Genital hypoplasia and Ear anomalies and/or deafness). The authors briefly describe the most salient clinical features and possible, though rare, complications of this anomaly (i.e., prolonged apnea, ab ingestis pneumonia, sinusitis, all the way to death by asphyxia). They also mention the current embryogenic theories advanced to explain the etiology. Foremost of these is the theory based on the persistence or inadequate development of the Hochstetter bucconasal membrane which is normally resorbed between the 35th and the 42nd day of intrauterine life, giving rise to the posterior nostril and primitive choana. The authors then present their personal experience with seven clinical cases of monolateral atresia in children ranging in age from 7 to 13 years, plus one case of bilateral atresia treated surgically 8 days after birth. They describe their surgical technique using intranasal and transseptal microsurgery. The patient undergoes general anesthesia in controlled hypotension. A surgical microscope with a 200-300 mm lens is used as well as the normal instrumentation for endonasal surgery. Access to the atresia lamina is gained through the floor of the nose and the lamina is perforated with a micro-osteotome. The excess bone tissue is removed and the neo-choana is calibrated and lined with the two mucosal flaps previously prepared. Then a silicone tube is positioned and anchored to the septum with a suture and left in place for approximately three weeks. Finally the authors indicate the most salient points of the other surgical techniques currently in use and they discuss their post-surgical treatment to prevent restenosis, comparing it with the experience of other authors.