Skull Base Anatomy in Patients with Bilateral Choanal Atresia: A Radiographic Study

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Medical Imaging

Background:

• Skull base injury risk during choanal atresia repair can be reduced with anatomical knowledge.
• Limited data exists on skull base anatomical differences in CHARGE syndrome patients.

Purpose of the Study:

• To measure and compare nasal and skull base anatomy in patients with isolated bilateral choanal atresia (BCA), CHARGE syndrome, and other syndromic congenital anomalies.
• To identify anatomical variations that may impact surgical approaches.

Main Methods:

• Retrospective review of 21 patients with bilateral choanal atresia and facial CT scans (2001-2019).
• Radiographic measurements included choanal width, height, mid-nasal height, and skull base slope.
• Statistical comparison between isolated BCA, CHARGE syndrome, and other congenital anomaly groups.

Main Results:

• No significant differences in skull base slope, choanal height, or width between isolated BCA and other congenital anomalies.
• CHARGE syndrome patients exhibited significantly shorter mid-nasal height compared to isolated BCA cases (p=0.03).
• Two patients with other congenital anomalies had preoperative bony skull base defects.

Conclusions:

• This study provides the largest description of skull base and nasal anatomy in CHARGE syndrome and BCA patients.
• Surgeons must recognize the lower skull base in CHARGE patients to prevent inadvertent injury.
• Awareness of CHARGE syndrome-specific anatomy is vital for safe choanal atresia repair.