Bilateral choanal atresia: key to success with the transnasal approach

The intranasal approach is generally accepted as the route of choice in the correction of bilateral choanal atresia but unfortunately it is associated with a significant incidence of stenosis. Over a five-year period, we have diagnosed bilateral choanal atresia in 30 neonates. Trans-nasal surgery was performed on 27 of them. All belonged to the Black race group. The incidence was 1:8,300 live births. There was a female predominance of 5:1. Four (13 per cent) had other associated anomalies. One was a twin. Various factors were analysed to determine the cause of the stenosis. These were: 1. Drilling compared with curettage of the bony atretic plate. 2. Stenting versus non-stenting. 3. Soft versus hard Portex tube stenting. 4. Variation of stenting period--six, eight and twelve weeks. 5. The use of prophylactic broad spectrum antibiotic for the whole of the stenting period. The conclusion derived from this study is that curettage of bony atresia, stenting with soft Portex tube for a period of six weeks and the use of broad spectrum antibiotic for the entire stenting period eliminates the problem of stenosis associated with the trans-nasal approach for the correction of bilateral choanal atresia.