Choanal Atresia: Surgical Management by Hegar's Dilators

Choanal atresia is one of the more commonly observed congenital abnormalities of the nose. The condition is predominantly found in females with a M:F ratio of 1:2. 65-75 % of patients with choanal atresia are unilateral, and the rest are bilateral. About 50 % of the cases are associated with other congenital anomalies, the most common being coloboma, Heart disease, choanal atresia, mental and growth retardation, genital hypoplasia, ear deformities syndrome. The embryonic origin of choanal atresia is due to persistent bucco-pharyngeal or naso-buccal membrane. Our study was a retrospective study of 14 cases of choanal atresia. All the cases were operated by the first author. Each patient was investigated in detail and recorded by stratifying in sex of patient, age of presentation, type and site of atresia, and associated other congenital anomalies. Patient were operated under general anesthesia and Hegar's dilators were used to perforate the atretic plate as Hegar's dilators are believed to have ideal curvature with respect to the sloping contour of the nasal floor. Out of the total 14 cases, 9 (64 %, n = 14) cases were male and 5 (36 %, n = 14) females. The age variations varied from youngest of 3 days to the oldest 31 year old female. Stents were kept for a period of 6-8 weeks and regular follow up nasal endoscopy was done weekly for suctioning and visualizing the size of the airway. There are five different surgical approaches that have been described for surgical treatment of choanal atresia: (1) trans-nasal, (2) trans-palatal, (3) trans-septal, (4) trans-antral and (5) sublabial-transnasal. In our study M:F ratio was 1.8:1 which is comparable Gosepath et al. (Rhinology 45:158-163, 2007) (2:1). In our study bilateral atresia was seen in 43 % (6, n = 14) and unilateral in 57 % (8, n = 14) which is comparable to Newman et al. (44 % bilateral cases, n = 43). Amicable and prompt referral to the ENT surgeon can be of immense value so as to buy adequate time for the surgeon to decide and act as per the patient's clinical and radiological findings. Hegar's dilator is passed along the floor of the nose, pushed against the septum so as to avoid penetrating the basal sphenoid.