Management of Choanal Atresia Saad AL-juboori

Abstract

Background: Choanal Atresia is a congenital disorder in which the posterior choanae unilaterally or bilaterally fail to develop properly.The aim: To evaluate the effectiveness of the available diagnostic methods and surgical techniques for the treatment of congenital choanal atresia . Patients and methods: A prospective study of Twenty one patients The diagnosis was based on clinical examination, and by the following:1.Cold spatula test.2.Failure of passage of 6 -8F catheter tube.3.CT to confirm the diagnosis and evaluate the type and thickness of the atretic plate..4. Endoscopic nasal examination.Results: 15 of our patients were females and6 were males with age ranging between 1 day and 25 years. There was only one adult, the rest of our patients were children. 14 of our patients had unilateral atresia , and 7 had bilateral atresia. Eighteen of the patients showed mixed bony and membranous atresia, by CT scan , 3 cases show pure bony atresia . There was no case with a pure membranous atresia.Thirteen of the unilateral Choanal atresia involved the right side, and only 1 Case had left sided atresia (7.6 % ).A total of 3 cases were associated with other congenital anomalies 14 % .All of them had bilateral choanal atresia. Two of them were with atrial septal defect and one had ventricular septal defect.Ten of our patients were treated by trans-nasal non-endoscopic surgical approach Two of our patients treated by trans-palatal approach Nine of our patients underwent transnasal endoscopic surgical approach Stent was used postoperatively in 13 of our cases for 6 weeks. Only 2 of our patients who underwent surgical intervention had restenosis and required revision surgery . Conclusion: Although the transnasal endoscopic approach requires experience, special equipments and with prolonged duration of surgery, it is more accurate , minimal invasive method and provides an excellent visualization of the plate.