[Congenital choanal atresia and surgical correction]

43 cases with congenital choanal atresia were observed in over 20 years. The indications for surgery of congenital choanal atresia and the different surgical approaches are discussed in detail. The transnasal approach should be performed in emergency situations or as first-aid treatment; the transmaxillary approach cannot be recommended any longer. The transpalatinal approach with the head in inclined position under microsurgical conditions has proved to be the surgical procedure of choice in most situations. 40 patients were operated on during infancy or childhood and followed up subsequently. 5 children showed bilateral choanal atresia; the other patients had unilateral complete atresia. In 9 patients a transnasal approach was performed, in 7 cases there was recurrence of complete stenosis; after transpalatinal re-operations, relapse occurred in one case only. One patient was operated on via the transmaxillary approach. In 30 cases the transpalatinal approach was the method of operation; relapse was seen in 6 cases only and could be revised by transpalatinal approach, excepted for one case. Our own experience and the present results show that the transpalatinal approach is suitable for adults as well as newborn and infants. On account of the better view of the operating area and optimal conditions for reconstruction, the transpalatinal approach is safer and long-term results are good.