Abstract
Objective
To report the method and results of endonasal endoscopic approach in congenital choanal atresia in cases of craniofacial malformation.
Patients
The pathology of unilateral and bilateral choanal atresia and the treatment results in seven children treated between 1999 and 2006 are presented. 5 infants suffering from bilateral atresia also had severe malformations (Charge syndrome [2 patients], trisomy 18, microcephalus, central cranioschisis, cleft lip and anophthalmia 9). The surgical intervention was carried out immediately after birth. 2 patients with unilateral atresia were treated in their second and sixth year of life respectively. CT scan was the diagnostic procedure of choice. Intraoperative endoscopy showed both membraneous and osseous atresia.
Surgical procedure
Trocars of different sizes were used to open the atresia plate, while the osseous parts were removed with diamond drills. Silicone tubes were inserted transnasally and remained in place for several months to improve the infants’ability to breath and drink.
Results
In all cases of bilateral atresia the tubes either had to be changed repeatedly or replaced with larger tubes due to dislocation and head growth. The septum was perforated in one case. No further stenoses were detected following the removal of the tubes (after 3–6 months).
Conclusion
The transnasal access is particularly suited to newborns and infants because it induces a minor surgical trauma and carries a low risk of bleeding if endoscopes are used. The results show that the risk of restenoses can be minimised with sufficient fixating and in-patient care.
Keywords: Choanal atresia, Craniofacial malformation, Surgical procedure
Full Text
The Full Text of this article is available as a PDF (232.3 KB).
References
- 1.Belenky W.M. Nasal obstruktion and rhinorrhea. In: Bluestone CDE Stool, editor. Pediatric Otolaryngology. 2nd edition. Philadelphia. London: W.B. Saunders Company; 1990. [Google Scholar]
- 2.Brunk A. Ein neuer Fall von einseitigem knöchernem Choanalverschluß. Operationsversuch vom Gaumen. Z. Ohrenheilkunde. 1909;59:221. [Google Scholar]
- 3.Deitmer T. Ätiologisch unklare Nasenstenosen bei Neugeborenen. Laryng Rhinol Otol. 1997;73:591–594. doi: 10.1055/s-2007-997202. [DOI] [PubMed] [Google Scholar]
- 4.Grevers G., Vogl T. Computertomographische Darstellung der Choanalatresie. Laryng Rhinol Otol. 1988;67:23–24. doi: 10.1055/s-2007-998438. [DOI] [PubMed] [Google Scholar]
- 5.Hengerer A.S., Strome M. Choanal atresia: A new embryologic theory and its influence on surgical management. Laryngoscope. 1982;92(8Pt1):913–921. [PubMed] [Google Scholar]
- 6.Josephson G.D., Vickery C.L., Giles W.C., Gross C.W. Transnasal endoscopic repair of congenital choanal atresia: long term results. Arch. Otlaryngol Head and Neck Surg. 1998;124(5):537–540. doi: 10.1001/archotol.124.5.537. [DOI] [PubMed] [Google Scholar]
- 7.Jung H. Die angeborene Choanalatresie und deren operative Korrektur. Laryng Rhinol Otol. 1994;73:586–590. doi: 10.1055/s-2007-997201. [DOI] [PubMed] [Google Scholar]
- 8.Legler U. Mißbildungen der Nase (mit Ausnahme der Gaumenspalten), Fremdkörper, Nasenbluten. In: Berendes, Link J.R., Zöllner F., editors. Hals-Nasen-Ohrenheilkunde in Praxis und Klinik. Stuttgart: Thieme; 1974. [Google Scholar]
- 9.Panwar S.S., Martin F.W. Transnasal endoscopic holmium: YAG laser correction of choanal atresia. J Laryngol Otol. 1996;110(5):429–431. doi: 10.1017/S0022215100133894. [DOI] [PubMed] [Google Scholar]
- 10.Peters H., Pontz B.F. Klinisches Bild und Verlauf von Kindern mit Charge-Association. Monatsschr. Leinderheilkd. 1988;136:690–693. [PubMed] [Google Scholar]
- 11.Lazar R.H., Younis R.T. Transnasal repair of choanal atresia using telescopes. Arch Otolaryngol Head Neck Surg. 1995;121(5):517–520. doi: 10.1001/archotol.1995.01890050015003. [DOI] [PubMed] [Google Scholar]
- 12.Robert J. Shprintzen Genetics, syndromes, and communication disorders. London: Singular Publishing; 1977. [Google Scholar]
- 13.Rudert H. Kombiniert transseptale-transnasale Chirurgie einseitiger Choanalatresien ohne Verwendung von Platzhaltern. Laryngo-Rhino-Otol. 1999;78:697–702. doi: 10.1055/s-1999-8772. [DOI] [PubMed] [Google Scholar]