Endoscopic Repair of Bilateral Choanal Atresia, Starting with Vomer Resection: Evaluation Study

• Published in: American journal of rhinology & allergy 2016-05, Vol.30 (3), p.e95-e99
• Main Authors: El-Anwar, Mohammad Waheed, Nofal, Ahmad Abdel Fattah, El-Ahl, Magdy Abdalla Sayed
• Format: Article
• Language: English
• Subjects: Choanal Atresia - surgery; Endoscopy; Female; Follow-Up Studies; Humans; Infant, Newborn; Male; Optical Fibers; Postoperative Complications; Treatment Outcome; Vomer - surgery
• ISSN: 1945-8924; 1945-8932; 1945-8932
• DOI: 10.2500/ajra.2016.30.4321

Background Choanal atresia is the most common inborn nasal anomaly, and its definitive treatment is surgical to achieve proper bilateral nasal patency. Four main surgical approaches were used for repair: transantral, transpalatal, transseptal, and transnasal. The transnasal endoscopic approach is the most widely accepted nowadays. In this study, we aimed to evaluate the long-term results of a transnasal endoscopic repair of congenital choanal atresia started with resection of the posterior portion of the vomer and was completed without the use of stents in a large series of patients. Methods Twenty-five patients (age range, 3-15 days) with bilateral congenital choanal atresia had surgery by using stentless endoscopic transnasal repair by starting with resection of the vomer bone. Postoperative control included office fiberoptic nasal endoscopy. Results During the follow-up period of 15-66 months (mean [standard deviation], 35.76 ± 16.8 months), 18 patients (72%) had a wide choana with adequate nasal breathing; Six patients (24%) had narrowing of the choana (50%) after 7 months, which necessitated repeated surgery. One patient (the fourth case) developed a palatal defect, which healed conservatively. No other complications were detected. Conclusion The described technique proved to be effective and easier, with good long-term satisfactory results in a large series of patients. This technique allows early use of both nasal passages for simultaneous endoscope and instrument insertion to excise both atretic plates without the use of stents or flaps.