Abstract
Purpose
To evaluate the outcome of a routine postoperative endoscopic micro-debridement of granulation tissue after stentless transnasal endoscopic repair of choanal atresia (CA).
Methods
This prospective case series included congenital CA patients who underwent stentless transnasal endoscopic repair, followed by an endoscopic second look and micro-debridement of granulation tissue at 1–2 weeks post-repair. Patients were followed every three months for assessment of nasal airway symptoms and objective evaluation by flexible nasolaryngoscopy.
Results
Sixteen CA patients (8 bilateral and 8 unilateral) underwent surgical repair (12 primary and 4 revisions). The median age was 13 days (range 1 day–6 months) in bilateral and 3 years (range 7 months–15 years) in unilateral atresia. The mean follow-up was 1.5 years (range 1 year–3 years). In primary procedures, the obstruction was bony-membranous in 7 cases and bony in 5 cases. The mean interval time between the CA repair and re-examination was 10.75 days (range 6–18 days). Clinically significant neochoanal restenosis was not encountered.
Conclusions
Re-examination under general anesthesia with endoscopic micro-debridement of granulation tissue is a safe, potentially effective adjunct when done during the proliferative phase of neochoanal wound healing. This procedure might help in maintaining neochoanal patency by remodeling tissue healing process. Large-scale, long-term cohort studies are imperative.
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All authors contributed to the study conception. Procedure, data collection, and interpretation were performed by AA. The first draft of the manuscript was written by DA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Approval was obtained from the ethics committee of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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Supplementary file1 Online Resource 1 Endoscopic bilateral choanal atresia repair for a 13-day-old girl illustrates the critical steps of the procedure. Step 1: identifying the boundaries of the atretic plate; Step 2: raising a laterally based mucosal flap bilaterally; Step 3: resecting the posterior septum and atretic plate; Step 4: resecting the nasopharyngeal mucosa of the atretic plate; Step 5: removal of the medially projected bone of the medial pterygoids; Step 6: repositioning the mucosal flaps to the cover the lateral exposed bones of the neochoana. (MP4 88223 KB)
Supplementary file2 Online Resource 2 Endoscopic second look and granulation tissue debridement of the noechoana at one week post-endoscopic repair of a 13-day-old girl with bilateral congenital choanal atresia. (MP4 17676 KB)
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AlKhateeb, A., Alrusayyis, D. Can a second look improve the outcome of endoscopic choanal atresia repair?. Eur Arch Otorhinolaryngol 281, 1331–1336 (2024). https://doi.org/10.1007/s00405-023-08323-z
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DOI: https://doi.org/10.1007/s00405-023-08323-z