Abstract
Background
Choanal Atresia (CA) is potentially life-threatening and its repair has a variable revision rate.
Objectives
A case series study from 1997 to 2017 to evaluate the results of repair of CA and review factors affecting outcome.
Methods
Forty-two patients aged one day to 16 years were included. The outcome measures were the number of revision operations and the length of time over which surgery was required. A focused review of the recent literature (2000–2018) was done.
Results
Bilateral cases (17) had a mean of 5.24 operations compared to 2.2 operations in unilateral cases (25). Nine patients had bony CA and required 3.56 operations, twenty-four patients had mixed CA and required 3.58 operations. Twelve patients with comorbidities required more operations. Patients with reflux disease required a mean of 4.67 operations.
Conclusion
An increased rate of restenosis was found in patients with bilateral CA, GERD and those with comorbidities. Parents should be counselled regarding the likelihood of revision surgery. Use of stents or Mitomycin C did not impact the revision rate in this series.
Similar content being viewed by others
Availability of data and material
Upon request.
References
Hengerer A, Brickman T, Jeyakumar A (2008) Choanal atresia: embryologic analysis and evolution of treatment, a 30 year experience. The Laryngoscope 118(5):862–866
Cedin A, Fujita R, Laercio O (2006) Endoscopic transeptal surgery for choanal atresia with a Stentless folded-over-flap technique. Sao Paulo Otolaryngol Head Neck Surg 135:693–698
Ramsden J, Campisi P, Forte V (2009) Choanal atresia and choanal stenosis. Toronto OtolaryngolClin North Ame 42:339–352
Teissier N, Kaguelidou F, Couloigner V, Francois M, Den Van Abbeele T (2008) Predictive factors for success after transnasal endoscopic treatment of choanal atresia. Arch Otolaryngol Head Neck Surg 134(1):57–61
Brown OE, Pownell P, Manning SC (1996) Choanal atresia: a new anatomic classification and clinical management applications. Laryngoscope 106:97–101
Schoem S (2004) Transnasal endoscopic repair of choanal atresia: why stent? Connecticut Otolaryngol-Head Neck Surg 131(4):362–366
Yaniv E, Hadar T, Shvero J, Stern Y, Raveh E (2007) Endoscopic transnasal repair of choanal atresia. Int J PediatrOtorhinolaryngol 71:457–462
Velegrakis S, Mantsopoulos K, Iro H, Zenk J (2013) Long-term outcomes of endonasal surgery for choanal atresia: 28 years’ experience in an academic medical centre. Eur Arch Otorhinolaryngol 270:113–116
Kim H, Park JH, Chung H, Han DH, Kim DY, Lee CH, Rhee CS (2012) Clinical features and surgical outcomes of congenital choanal atresia: factors influencing success from 20 year review in an institute. Am J Otolaryngol 33(3):308
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 outcomes. Int J PediatrOtorhinolaryngol 76(5):613–617
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. In J PediatrOtorhinolaryngol 68:939–945
Manica D, Schweiger CN, Kuhl CS, G, (2014) Retrospective study of a series of choanal atresia patients. Intl Arch Otorhinolaryngol 18:2–5
Moreddu E, Rossi ME, Nicollas R, Triglia JM (2019) Prognostic factors and management of patients with choanal atresia. J Pediatr 204:234–239
De Freitas RP, Berkowitz RG (2012) Bilateral choanal atresia repair in neonates—a single surgeon experience. Int J PediatrOtorhinolaryngol 76(5):613–617
Samadi DS, Udayan KS, Handler SD (2003) Choanal atresia: a twenty-year review of medical comorbidities and surgical outcomes. The Laryngoscope 113(2):254–258
Bozkurt MK, Keles B, Azimov A, Ozturk K, Arbag H (2010) The use of adjunctive topical mitomycin in endoscopic congenital choanal atresia repair. Int J PediatrOtorhinolaryngol 74(7):733
Brihaye P, Delpierre I, De Villé A, Johansson AB, Biarent D, Mansbach AL (2017) Comprehensive management of congenital choanal atresia. Int J PediatrOtorhinolaryngol 98:9–18. https://doi.org/10.1016/j.ijporl.2017.04.022
Riepl R, Scheithauer M, Hoffmann TK, Rotter N (2014) Transnasal endoscopic treatment of bilateral choanal atresia in newborns using balloon dilatation: own results and review of literature. Int J PediatrOtorhinolaryngol 78(3):459–464
Ibrahim AA, Magdy EA, Hassab MH (2010) Endoscopic choanoplasty without stenting for congenital choanal atresia repair. Int J PediatrOtorhinolaryngol 74(2):144–150
Eladl HM, Khafagy YW (2016) Endoscopic bilateral congenital choanal atresia repair of 112 cases, evolving concept and technical experience. Int J PediatrOtorhinolaryngol 85:40–45
Strychowsky JE, Kawai K, Moritz E, Rahbar R, Adil EA (2016) To stent or not to stent? A meta-analysis of endonasal congenital bilateral choanal atresia Repair. Laryngoscope 126(1):218–227. https://doi.org/10.1002/lary.25393 (Epub 2015 May 25)
Gangar M, Bent JP (2014) The use of mitomycin C in pediatric airway surgery: does it work? CurrOpinOtolaryngol Head Neck Surg 22(6):521–524
Karligkiotis A, Farneti P, Gallo S, Pusateri A, Zappoli-Thyrion F, Sciarretta V, Pagella F, Castelnuovo P, Pasquini E (2017) An Italian multicentre experience in endoscopic endonasal treatment of congenital choanal atresia: proposal for a novel classification system of surgical outcomes. J CraniomaxillofacSurg 45(6):1018–1025
Hartnick CJ, Hartley BE, Lacy PD, Liu J, Bean JA, Willging JP, Myer CM 3rd, Cotton RT (2001) Topical mitomycin application after laryngotracheal reconstruction: a randomized, double-blind, placebo-controlled trial. Arch Otolaryngol Head Neck Surg 127(10):1260–1264
Romeh HE, Albirmawy OA (2010) A 13 year experience and predictors for success in transnasal endoscopic repair of congenital choanal obliteration. Int J PediatrOtorhinolaryngol 74(7):737–742
Robert Newman J, Paula Harmon W, Peyton Shirley J, Hill S, Woolley AL, Wiatrak BJ (2013) Operative management of choanal atresia a 15 year experience. JAMA Otolaryngol Head Neck Surg 139(1):71–75
Wolf A, Lang-Loidolt D, Koele W, Wolf G, Thurnher D, Stammberger H, Tomazic PV (2016) Are stents beneficial in endoscopic choanal atresia repair of newborns and children? Case series of 11 patient. ClinOtolaryngol 41(6):821–825. https://doi.org/10.1111/coa.12566 (Epub 2016 Feb 11)
Carter JM, Lawlor C, Guarisco JL (2014) The efficacy of mitomycin and stenting in choanal atresia repair: a 20 year experience. Int J PediatrOtorhinolaryngol 78(2):307–311. https://doi.org/10.1016/j.ijporl.2013.11.031 (Epub 2013 Dec 3)
Elloy MD, Cochrane LA, Albert DM (2008) Refractory choanal atresia: what makes a child susceptible? The great ormond street hospital experience. J Otolaryngol Head Neck Surg 37(6):813–820
Funding
All this work was done at Sheffield children hospital; we did not receive any additional funds.
Author information
Authors and Affiliations
Contributions
AH is the primary author and editor of this article. CM was responsible for data collection and analysis and drafting of the article. TR is the senior author and was involved in conception, design of the work and critical revision.
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Attya, H., Callaby, M. & Thevasagayam, R. Choanal atresia surgery: outcomes in 42 patients over 20 years and a review of the literature. Eur Arch Otorhinolaryngol 278, 2347–2356 (2021). https://doi.org/10.1007/s00405-020-06506-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-020-06506-6