Congenital posterior choanal atresia

Forty-eight cases of congenital bony posterior choanal atresia are reviewed revealing a 64% incidence of unilateral atresia with no correlation existing between sex and side of involvement. Bilateral atresia presents soon after birth with respiratory problems whereas feeding difficulties and nasal discharge are the predominant features of unilateral atresia. Other congenital anomalies existed in 48% with 82.5% being major or multiple. The implications of this are discussed. Early surgical repair is advocated. Transpalatal and endonasal approaches yield initial success rates of 57% and 59% respectively with similar frequency of subsequent dilatations being necessary in the initial failure groups to obtain long-term success. Regular prophylactic bougienage by the parents does not appear to alter the outcome significantly.