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Current Management of Congenital Choanal Atresia

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Abstract

Background

Congenital Choanal Artesia (CCA) is a rare cause of upper airway obstruction, yet it is the most common congenital anomaly of the nose. While the unilateral condition could be undiagnosed, bilateral CCA may be life-threatening, especially for newborns. Some CCA may be associated with other congenital abnormalities, which leads to a systematic screening during the diagnostic assessment. The diagnosis is easy. However, surgical management is still controversial.

Methods

We conducted a retrospective study gathering data on management of CCA over 42 months. We reported epidemiological aspects and results of our series, and discussed management issues.

Results

We operated 22 choanae using the endoscopic technique. The age of bilateral CCA patients on the day of surgery ranged from 8 to 21 days (mean 11.7+/_ 2.6 days). Their birth weight ranged from 2.9 to 4.5 kg (mean 3.4 +/_ 0.5 kg), and their gestational age ranged from 30 to 41 weeks. Surgery duration for neonatal bilateral CCA repair ranged from 75 to 110 min (mean 90 min +/_ 11.5 min). We performed an exclusive endonasal endoscopic approach for all patients with no stenting or mitomycin C application. We deplore one post operative complication related to minor palatal perforation resolved spontaneously.

Conclusion

Since newborns solely depend on nasal breathing during the first month of life, bilateral CCA is an emergency. Endonasal endoscopic management is the primary procedure. Currently, surgery steps are standardized. However, how to prevent post-operative synechiae and restenosis is still controversial. The mainstream is meticulous post-operative nursing with frequent endonasal saline irrigation, regular removal of crust, and prevention of inflammation due to reflux or infection.

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References:

  1. Al-Qahtani AS, Farouk MA, Messahel (2003) Choanal atresia repair: the use of reinforced silicone tube to prevent restenosis.Rhinology. 41:54–551

  2. Teissier N, Kaguelidou F, Couloigner V, Francois M, Van Den Abbeele T (2008) Predictive factors for success after transnasal endoscopic treatment of choanal atresia. Archives of Otolaryngology–Head & Neck Surgery. ; 134(1): 57–61 doi:https://doi.org/10.1001/archoto.2007.20

  3. Brown OE, Powell P, Manning SC (1996) Choanal atresia: a new anatomic classifications and clinical management applications. Laryngoscope 106(1):97–101. doi:https://doi.org/10.1097/00005537-199601000-00019

    Article  CAS  PubMed  Google Scholar 

  4. Morgan DW, Bailey CM (1990) Current management of choanal atresia. Int J Pediatr Otorhinolaryngol 19(1):1–13. doi: https://doi.org/10.1016/0165-5876(90)90191-s

    Article  CAS  PubMed  Google Scholar 

  5. Stankiewicz JA (1990) The endoscopic repair of choanal atresia. Otolaryngol -Head Neck Surg 103(6):931–937. doi:https://doi.org/10.1177/019459989010300608

    Article  CAS  PubMed  Google Scholar 

  6. Carpenter RJ, Neel HB (1977) Correction of congenital choanal atresia in children and adults. Laryngoscope 87(8):1304–1311. doi:https://doi.org/10.1288/00005537-197708000-00010

    Article  CAS  PubMed  Google Scholar 

  7. Krespi YP, Husain S, Levine TM, Reede DL (1987) Sublabial transseptal repair of choanal atresia or stenosis. Laryngoscope 97(12):1402–1406. doi:https://doi.org/10.1288/00005537-198712000-00005

    Article  CAS  PubMed  Google Scholar 

  8. Ibrahim AA, Magdy EA, Hassab MH (2010) Endoscopic choanoplasty without stenting for congenital Choanal Atresia Repair. Int J Pediatr Otorhinolaryngol 74(2):144–150. doi: https://doi.org/10.1016/j.ijporl.2009.10.027

    Article  PubMed  Google Scholar 

  9. Gujrathi CS, Daniel SJ, James AL, Forte V (2004) Management of bilateral choanal atresia in the neonate: an institutional review. Int J Pediatr Otorhinolaryngol 68(4):399–407. doi: https://doi.org/10.1016/j.ijporl.2003.10.006

    Article  CAS  PubMed  Google Scholar 

  10. Deutsch E, Kaufman M, Eilon A (1997) Transnasal endoscopic management of choanal atresia. Int J Pediatr Otorhinolaryngol 40(1):19–26. doi:https://doi.org/10.1016/s0165-5876(96)01486-3

    Article  CAS  PubMed  Google Scholar 

  11. Al-Khatib T (2018) Transoral approach for choanal atresia repair: a new surgical innovation in the making. J Otolaryngol ENT Res 10(2):107–108. doi:https://doi.org/10.15406/joentr.2018.10.00323

    Article  Google Scholar 

  12. Samadi DS, Shah UK, Handler SD (2003) Choanal atresia: a twenty-year review of medical comorbidities and surgical outcomes. Laryngoscope 113(2):254–258. doi:https://doi.org/10.1097/00005537-200302000-00011

    Article  PubMed  Google Scholar 

  13. Antigoni K, Apr An A (2010) Alex And Er Karatzanis 1st Elios, Velegrakis.Endonasal management of choanal atresia with the use of a surgical microscope; Otorhinolaryngology - Head and Neck Surgery Issue 42, October–November–December pp. 20–24

  14. Ted L, Tewfik, Abdulrahman A, Hagr (2019) Choanal Atresia. The eMedicine Clinical Knowledge Base, Institutional Edition.Medscape Update September03,

  15. Cedin AC, Atallah AN, Andriolo RB, Cruz OL, Pignatari SN (2012) Surgery for congenital choanal atresia. Cochrane Database of Systematic Reviews : CD 008993. doi: https://doi.org/10.1002/14651858. CD008993.pub2

  16. Emmert C Stenochorie und Atresie der Choanen, Lehrbuch der Speziellen Chirurgie (Vol.2). Stuttgart: Dann (1854). p: 535 – 8

  17. Kwong KM (2015) Current updates on choanal atresia. Frontiers in Pediatrics. ; 3. doi: 10.3389/ fped. 2015.00052

  18. Holland BW, McGuirt WF (2001) Surgical management of choanal atresia. Archives of Otolaryngology–Head & Neck Surgery 127(11):1375–1380. doi:https://doi.org/10.1001/archotol.127.11.1375

    Article  CAS  Google Scholar 

  19. Park AH, Brockenbrough J, Stankiewicz J (2000) Endoscopic versus traditional approaches to choanal atresia. Otolaryngologic clinics of North America. 33:77–90. https://doi.org/10.1016/S0030-6665(05)70208-5. 1

  20. Yaniv E, Hadar T, Shvero J, SternY, Raveh E (2007) Endoscopic transnasal repair of choanal atresia. International Journal of Pediatric Otorhinolaryngology ;71(3): 457–462 doi: https://doi.org/10.1016/j.ijporl.2006.11.012

  21. Durmaz A, Tosun F, Yldrm N, Sahan M, Kvrakdal C, Gerek M (2008) Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. J Craniofac Surg 19(5):1270–1274. doi:https://doi.org/10.1097/SCS.0b013e3181843564

    Article  PubMed  Google Scholar 

  22. Kubba H, Bennett A, Bailey CM (2004) An update on choanal atresia surgery at Great Ormond Street Hospital for Children: preliminary results with mitomycin C and the KTP laser. Int J Pediatr Otorhinolaryngol. ; 68(7): 939–945. doi: 10. 1016/j.ijporl.2004.02.010

  23. Uzomefuna V, Glynn F, Al-Omari B, Hone S, Russell J (2012) Transnasal endoscopic repair of choanal atresia in a tertiary care centre: a review of out- comes. International Journal of Pediatric Otorhinolaryngology.; 76(5):613–7. doi:https://doi.org/10.1016/j.ijporl. 2012.01.033

  24. Carter JM, Lawlor C, Guarisco JL (2014) The efficacy of mitomycin and stenting in choanal atresia repair: a 20-year experience. Int J Pediatr Otorhinolaryngol 78(2):307–311. doi: https://doi.org/10.1016/j.ijporl.2013.11.031

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine and Pharmacy, Sidi Mohammed Benabdellah University, Fez, Morocco

    Naouar Ouattassi, Akhana Asmae, Zouheir Zaki & Mohamed Nourredine EL Alami

  2. Department of Otorhinolaryngology (ENT) and head - neck surgery, Hassan II university hospital, Km 2.200, Sidi Hrazem Road, BP. 1893, 30000, Fez, Morocco

    ELguerch Wissam

Authors
  1. Naouar Ouattassi
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  2. ELguerch Wissam
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  3. Akhana Asmae
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  4. Zouheir Zaki
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  5. Mohamed Nourredine EL Alami
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Contributions

All authors have contributed to the diagnostic and therapeutic management of patients and to the writing of this work. All the authors contributed to the conduct of this work. All authors also declare that they have read and approved the final version of the manuscript.

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Correspondence to ELguerch Wissam.

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The authors declare that they have no conflicts of interest.

Ethical Considerations

The IRB of our institution approved the study protocol. We have obtained a well-informed consent form adult patients or the legal tutor of the young patients for using their clinical data in this study. Documents are available for the editor or reviewers for possible review.

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Ouattassi, N., Wissam, E., Asmae, A. et al. Current Management of Congenital Choanal Atresia. Indian J Otolaryngol Head Neck Surg 75, 2227–2234 (2023). https://doi.org/10.1007/s12070-022-03398-2

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  • DOI: https://doi.org/10.1007/s12070-022-03398-2

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