Neonatal Choanal Atresia and Stenosis

Choanal atresia (CA) and choanal stenosis (CS) are congenital obstruction or narrowing of the choanae, respectively. Neonates with bilateral CA present with respiratory distress shortly after birth and require patency of the oral airway and surgical correction of the defect, whereas patients with unilateral CA/CS can present later in infancy or even into adulthood and can often be managed medically. It is important to differentiate the symptoms of CA/CS from other causes of congenital nasal obstruction so that the appropriate medical and/or surgical management can be determined. A variety of embryologic explanations exist for the cause of CA/CS, with failed rupture of the oronasal membrane being the predominant theory. It is important to evaluate affected neonates for other anomalies based on risk factors and phenotypical features, as almost 75% of patients with CA/CS have associated craniofacial abnormalities or syndromes. Definitive diagnosis of CA/CS includes nasal endoscopy and computed tomography. Although a variety of surgical repair techniques exist for CA/CS, the transpalatal and endoscopic transnasal approaches are the mainstay, with the former reserved for nasal passages unable to accommodate an endoscope and surgical instruments simultaneously. Postoperative care includes saline rinses, frequent suctioning, and intranasal corticosteroids. Patients should be followed by an otolaryngologist for a minimum of 1 year after repair to monitor for restenosis.