Choanal Atresia - Definition, Causes, Symptoms and Treatment

Congenital Obstruction of The Posterior Nasal Apertures: Choanal Atresia

Choanal Atresia, Congenital Nasal Obstruction, Nasal Blockage in Newborn, CHARGE Syndrome, Neonatal Respiratory Distress

What is Choanal Atresia?

Choanal atresia is a congenital disorder that means that the "choanas", which are the nasal opening holes of the nose, located between the nasal passages and the nose, are closed by abnormal bone or soft tissue during fetal development.

Why Does Choanal Atresia Occur?

It occurs when the nasobuccal membrane, which should be perforated during embryological development, is not perforated and closes the choana. The tissue covering the choanas may contain bone or mucosa.

How Common Is Choanal Atresia?

The frequency of choanal atresia is seen once in 7000-8000 live births. It is twice as common in women. Atresia plaque in the bony structure is 9 times more common than the mucosal one. It is most common unilateral, 2 times more on the right side.

Diseases and Conditions Associated with Choanal Atresia

Choanal atresia can be seen with a group of diseases and anomalies called "CHARGE Syndrome". These diseases and conditions are:

C - coloboma of the eye (coloboma of the eye)
H - heart defects
A - atresia of the nasal choanae (nasal choanal atresia)
R - retardation of growth and / or development
G - genital and / or urinary abnormalities (genital and / or urinary abnormalities)
E - ear abnormalities and deafness (ear abnormalities and deafness)

How Is Choanal Atresia Diagnosed?

When babies are born, the airways are controlled with small catheters inserted backwards through the nostrils as standard. Choanal atresia is suspected in cases where the catheter cannot be advanced.

Rarely, unilateral choanal atresia can be skipped and diagnosis can be made even in adulthood. When bilateral choanal scales are present, easily noticeable symptoms such as breathing problems, cyanosis (bruising) and feeding difficulty can be encountered in babies. When choanal atresia is suspected, the diagnosis is confirmed radiologically, mostly computed tomography diagnosis is used. Quite simply, nasal congestion and choanal atresia may be suspected when a freshly dried watch is brought close to a baby's nostril if there is no steam.

In a baby born with nasal obstruction, congenital stenosis in priform structure, deviation or dislocation of the nasal septum, turbinate hypertrophy, intranasal neoplasms, and intranasal cystic structures can be considered among the differential diagnoses.

What Are the Risk Factors For Choanal Atresia?

Although the risk factors that may cause choana atresia have not been determined precisely; Few risk factors have been identified.

Choanal atresia may occur due to environmental and genetic factors.

In particular, pesticides used in agriculture, passive smoking (exposure to cigarette smoke), coffee consumption, excessive use of zinc and vitamin B12, and anti-infective drugs used in the urinary system are blamed.

Choanal Atresia Treatment

The definitive treatment of choanal atresia is to perforate the atresia plate and ensure that the nasal air space continues with the nasal area.

Choanal atresia surgery can be done in two different ways, as an emergency or elective. Bilateral choanal atresia cases in newborns require urgent diagnosis and airway stabilization. Oral airway, McGovern pacifier and intubation options are available.

Techniques used in choanal atresia surgery:

- Transnasal approach

In this technique, the procedure is done through the nose. In this technique, which can be performed with or without the use of a microscope, although tissue damage is low; surgical vision is inadequate compared to other techniques and the possibility of needing a second revision procedure is higher.

- Transseptal approach

In this technique, a window is opened in front of the nasal septum.

- Transpalatal approach

Transpalatal repair provides excellent visibility and although it has a high success rate; It is a technique that requires more operation time. Increased blood loss, possibility of palatal fistula, palatal dysfunction, and maxillofacial growth disorder are possible complications of this procedure.

Endoscopic (nasal or retropalatal) technique

It provides excellent imaging with great ease in removing the bony atresia plaque. The microdebriders used in this technique allow the hole in the atresia plate to be easily expanded by providing less tissue trauma for experienced surgeons.

After choanal atresia surgeries, stents extending from the nose to the nasal passage are usually placed to prevent the air gap from closing.

Unlike all these techniques, using a carbon dioxide and potassium titanyl phosphate (KTP) laser is generally not necessary to use a postoperative stent.

An endotracheal tube or Foley catheter is usually used as a stent.

After performing choanal atresia surgery, mitomycin C can be used in the plaque area.

Patient Care After Choanal Atresia Surgery

If a stent is used, antibiotic and antireflux treatment and moisturizing creams may be required for the outer nostrils. After surgical repair of choanal atresia, patients may need debridement of the surgical site or periodic dilatation. Periodic dilation can sometimes be done as an outpatient procedure with topical anesthesia using local decongestant and urethral sounds. In young babies, it is usually enough to apply creams to the tip of the nose, except for the renewal of the bands that keep the stents placed in the nose for 4-6 weeks.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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