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Sublabial transseptal repair of choanal atresia or stenosis
Y P Krespi1, S Husain, T M Levine
1Department of Otolaryngology, SUNY, Health Science Center, Brooklyn.
Insights
A novel sublabial transseptal repair effectively corrects choanal atresia or stenosis in infants, avoiding restenosis. This technique offers a promising alternative for treating this congenital condition.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Innovation
Background:
- Bilateral choanal atresia in infants presents significant health risks, necessitating prompt surgical intervention.
- Current transnasal approaches, while common, have a high rate of restenosis.
- The transpalatal route is typically reserved for older patients.
Purpose of the Study:
- To introduce and evaluate a new surgical technique, the sublabial transseptal repair, for choanal atresia or stenosis applicable to all age groups.
- To assess the safety and efficacy of this novel approach in infants, focusing on complication and restenosis rates.
Main Methods:
- The sublabial transseptal repair was performed on four infants, utilizing an operating microscope and micro-instruments.
- Key surgical steps included wide exposure of the nasal cavity and choanae, vomer removal, and preservation of nasal growth structures.
- Postoperative computed tomography (CT) scans were used for evaluation, and patients were stented with polyvinyl tubes for 8-10 weeks.
Main Results:
- The sublabial transseptal repair was successfully performed in all four infants without complications or restenosis.
- Two patients with prior failed repairs experienced persistent choanal stenosis, which was resolved with this new method.
- Follow-up of 2-4 years showed no recurrence of choanal stenosis.
Conclusions:
- The sublabial transseptal approach provides excellent exposure for choanal atresia repair in infants.
- This technique is effective in preventing restenosis and can be used in patients of any age, including those with prior surgical failures.
- Preservation of anatomical structures is crucial for maintaining normal nasal growth patterns.
Abstract:
Bilateral choanal atresia in newborns and infants carries significant morbidity and mortality, therefore, prompt correction is required. The transnasal route is usually preferred in the infant age group. This approach, however, carries significant incidence of restenosis. The transpalatal correction of choanal atresia has been the definitive approach in older children and adults. We are introducing a new procedure for correction of choanal atresia or stenosis that can be used at any age. The sublabial transseptal repair was performed in four infants without complications or restenosis. Two of our patients previously underwent different types of repair with persistent choanal stenosis. The sublabial transseptal approach provides wide exposure to the nasal cavity and the floor leading to the choanae. The operating microscope and various otologic micro-instruments were used in the surgical dissection. Preservation of the anterior inferior cartilaginous septum and the maxillary crest and spine is mandatory in order not to disturb the nasal growth pattern of the nose and premaxilla. The infants were evaluated with a computed tomography (CT) scan, preoperatively. The posterior inferior portion of the vomer is uniformly wide, increasing the degree of stenosis or atresia. Removal of the vomer is an essential part of this procedure in order to open and enlarge the choanae. Both choanae were stented with polyvinyl tubes. Every attempt was made to keep the stents in position for a minimum of 8 to 10 weeks. Follow-up has been for 2 to 4 years, and no recurrent choanal stenosis has been experienced.