Practical Tips for Surgical Management of Bilateral Choanal Atresia

Choanal atresia refers to congenital blockage of posterior choana of nose by the presence of a bony or membranous soft tissue. It causes respiratory distress in newborn which requires emergency surgical intervention. Various surgical methods are available for correction of choanal atresia and endoscopic approach is the commonly used one. However there is risk of re-stenosis after surgery. This article focuses on surgical refinements to improve the surgical outcome. It is a retrospective study done on eight newborns with bilateral congenital choanalatresia. Data included gestational age, any ante-natal issues, breathing activity at birth, diagnostic tests for choanal atresia and Head to Foot examination findings. Initial diagnostic work up included CT scan of paranasal sinus and Echocardiography to rule out associated cardiac anomalies. All the newborns were treated initially in NICU with ventilator support and then taken up for endoscopic correction of atresia. After surgery, newborns were successfully weaned off from ventilator. Among the 8 newborns, there were 5 males and 3 females and their gestational age was full term. (except in one). Initial presentation included respiratory distress on day 1 of life with difficulty in inserting feeding tube through the nose. Imaging showed bilateral atresia in 7 newborns and unilateral atresia in one newborn. 5 of them underwent atresia surgery using endoscopic approach. One newborn required revision surgery. Remaining newborns remained symptom free during the follow up period. Currently endoscopic approach remains a safer method for correction of choanal atresia with very minimal chance of re-stenosis. Surgical refinements like adequate widening of neo-choana and usage of mucosal flaps to cover the raw area has been found to improve the surgical outcome.