Endoscopic surgery in a child with unilateral choanal atresia
Abstract Introduction and objective: Choanal atresia is rare, being twice as common in women than in men, and in 50% of cases approximately it is associated with other congenital anomalies. Although there has been some controvesia about the treatment of choice of this malformation, in the last decade, the introduction of endoscopes in sinus surgery has improved the outcome. Case description: We report the case of a child who has left chronic rhinorrhea with persistent nasal obstruction. By endoscopy and CT diagnosis, left choanal atresia is confirmed. Unilateral choanal atresia endoscopic surgery is performed by creating flaps with intranasal mucosa, preventing nasal packing. Discussion: Different techniques have been considered for the treatment of choanal atresia, which include traditional and endoscopic approach. The results of endoscopic surgery in the choanal atresia vary according to different authors. The two most important aspects of these results are the creation of nasal mucosa flaps and avoiding nasal packing. Conclusions: Surgical treatment of unilateral choanal atresia by endoscopic surgery can reduce the risk of restenosis.
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Otto W. Lehrbuch der pathologie, Anatomy des Menchen und der Thiere. Vol I. Berlin, Alemania. A Ruecker, 1830. pp. 180-3.
Emmert C. Steneochorie und atresia der choannen. En Lehrbuch der Speciellen Chirurgie (Vol. 2). Stuttgart, Alemania. Dann, 1954. pp. 535-8.
Metin Önerci T, Taskin Yücel Ö, Ögretmenoglu O. Transnasal endoscopic surgery in choanal atresia. Operative Techniques in Otolaryngology 2006;17:143-6.
http://dx.doi.org/10.1016/j.otot.2006.01.013
Hengerer AS, Newburg J. Congenital malformations of the nose ad paranasal sinuses. En Bluestone CD, Stool SE (Eds): Pedriatric Otolaryngology (Ed). Filadelfia, Saunders, 1990. pp. 727-8.
Morgan DW, Bailey CM. current management of choanal atresia. Int J Pediatr Otorhinolaryngol 1990;19:1-13.
http://dx.doi.org/10.1016/0165-5876(90)90191-S
Kaplan LC. The CHARGE association: choanal atresia ad multiple congenital anomalies. Otolaryngol Clin North Am 1989;22:661-72.
PMid:2498809
Fraser JS. Congenital atresia of the choane. Br J Med 1910;2:1698-701.
Brown OE, Powenell P, Manning SC. Choanal atresia. A new anatomic classification ad clinical management applications. Laryngoscope 1996;106:97-101.
http://dx.doi.org/10.1097/00005537-199601000-00019
PMid:8544637
Carpenter RJ, Neel HB. III: Correction of congenital choanal atresia in children and in adults. Laryngoscope 1977;87:1304:11.
Owens H. Observations in treating twenty-five cases of choanal atresia by transpalatine approach. Laryngoscope 1965;75:84-104.
http://dx.doi.org/10.1288/00005537-196501000-00011
PMid:14256356
Park HA, Brockenbrough J, Stankiewicz J. Endoscopic versus traditional approaches to choanal atresia. Otolaryngol Clin North Am 2000;33:77-90.
http://dx.doi.org/10.1016/S0030-6665(05)70208-5
Krespi YP, Husain S, Levine TM, Reede DL. Sublabial transseptal repair of choanal atresia or stenosis. Laryngoscope. 1987;97:1402-6.
http://dx.doi.org/10.1288/00005537-198712000-00005
PMid:3683051
Stankiewicz JA. The endoscopic repair of choanal atresia. Otolaryngol Head Neck Surg 1990;103:931-7.
PMid:2126127
Schoem SR. Transnasal endoscopic repair of choanal atresia: Why stent? Otolaryngol Head Neck Surg 2004;131:362-6.
http://dx.doi.org/10.1016/j.otohns.2004.03.036
PMid:15467600
Van Den Abbeele T, Francois M, Narcy P. Transnasal endoscopy treatment of choanal atresia without prolonged stenting. Arch Otolaryngol Head Neck Surg 2002;128:936-40.
http://dx.doi.org/10.1001/archotol.128.8.936
PMid:12162774
Mcleod IK, Brooks DB, Mair EA. Revision choanal atresia repair. Int J Pediatr Otorhinolaryngol 2003;67:517-24.
http://dx.doi.org/10.1016/S0165-5876(03)00012-0
Holzmann D, Ruckstuhl M. Unilateral choanal atresia: surgical technique ad longterm results. J Laryngol Otol 2002;116:601-4.
http://dx.doi.org/10.1258/00222150260171588
PMid:12389687
Dedo H. transnasal mucosal flag rotation technique for repair of posterior choanal atresia. Otolaryngol Head Neck Surg 2001;124:674-82.
http://dx.doi.org/10.1067/mhn.2001.116037
PMid:11391260
Uzomefuna V, Fergal Glynn F, Al-Omari B, Hone S, Russell, J. Transnasal endoscopic repair of choanal atresia in a tertiary care centre: A review of outcomes. Int J Ped Otorhinolaryngol 2012; 76:613-17.
http://dx.doi.org/10.1016/j.ijporl.2012.01.033
PMid:22418073
Bozkurt MK, Keles B, Azimov A, Ozturk K, Arbag, H. The use of adjunctive topical mitomycin in endoscopic congenital choanal atresia repair. Int J Ped Otorhinolaryngol 2010;74:733-36.
http://dx.doi.org/10.1016/j.ijporl.2010.03.026
PMid:20394996
Llorente JL, López F, Morato M, Suárez V, Coca A, Suárez C. Endoscopic treatment of choanal atresia. Acta Otorrinolaringol Esp. 2013;64(6):389-95.
http://dx.doi.org/10.1016/j.otorri.2013.05.001
http://dx.doi.org/10.1016/j.otoeng.2013.11.006
PMid:23896489
Emmert C. Steneochorie und atresia der choannen. En Lehrbuch der Speciellen Chirurgie (Vol. 2). Stuttgart, Alemania. Dann, 1954. pp. 535-8.
Metin Önerci T, Taskin Yücel Ö, Ögretmenoglu O. Transnasal endoscopic surgery in choanal atresia. Operative Techniques in Otolaryngology 2006;17:143-6.
http://dx.doi.org/10.1016/j.otot.2006.01.013
Hengerer AS, Newburg J. Congenital malformations of the nose ad paranasal sinuses. En Bluestone CD, Stool SE (Eds): Pedriatric Otolaryngology (Ed). Filadelfia, Saunders, 1990. pp. 727-8.
Morgan DW, Bailey CM. current management of choanal atresia. Int J Pediatr Otorhinolaryngol 1990;19:1-13.
http://dx.doi.org/10.1016/0165-5876(90)90191-S
Kaplan LC. The CHARGE association: choanal atresia ad multiple congenital anomalies. Otolaryngol Clin North Am 1989;22:661-72.
PMid:2498809
Fraser JS. Congenital atresia of the choane. Br J Med 1910;2:1698-701.
Brown OE, Powenell P, Manning SC. Choanal atresia. A new anatomic classification ad clinical management applications. Laryngoscope 1996;106:97-101.
http://dx.doi.org/10.1097/00005537-199601000-00019
PMid:8544637
Carpenter RJ, Neel HB. III: Correction of congenital choanal atresia in children and in adults. Laryngoscope 1977;87:1304:11.
Owens H. Observations in treating twenty-five cases of choanal atresia by transpalatine approach. Laryngoscope 1965;75:84-104.
http://dx.doi.org/10.1288/00005537-196501000-00011
PMid:14256356
Park HA, Brockenbrough J, Stankiewicz J. Endoscopic versus traditional approaches to choanal atresia. Otolaryngol Clin North Am 2000;33:77-90.
http://dx.doi.org/10.1016/S0030-6665(05)70208-5
Krespi YP, Husain S, Levine TM, Reede DL. Sublabial transseptal repair of choanal atresia or stenosis. Laryngoscope. 1987;97:1402-6.
http://dx.doi.org/10.1288/00005537-198712000-00005
PMid:3683051
Stankiewicz JA. The endoscopic repair of choanal atresia. Otolaryngol Head Neck Surg 1990;103:931-7.
PMid:2126127
Schoem SR. Transnasal endoscopic repair of choanal atresia: Why stent? Otolaryngol Head Neck Surg 2004;131:362-6.
http://dx.doi.org/10.1016/j.otohns.2004.03.036
PMid:15467600
Van Den Abbeele T, Francois M, Narcy P. Transnasal endoscopy treatment of choanal atresia without prolonged stenting. Arch Otolaryngol Head Neck Surg 2002;128:936-40.
http://dx.doi.org/10.1001/archotol.128.8.936
PMid:12162774
Mcleod IK, Brooks DB, Mair EA. Revision choanal atresia repair. Int J Pediatr Otorhinolaryngol 2003;67:517-24.
http://dx.doi.org/10.1016/S0165-5876(03)00012-0
Holzmann D, Ruckstuhl M. Unilateral choanal atresia: surgical technique ad longterm results. J Laryngol Otol 2002;116:601-4.
http://dx.doi.org/10.1258/00222150260171588
PMid:12389687
Dedo H. transnasal mucosal flag rotation technique for repair of posterior choanal atresia. Otolaryngol Head Neck Surg 2001;124:674-82.
http://dx.doi.org/10.1067/mhn.2001.116037
PMid:11391260
Uzomefuna V, Fergal Glynn F, Al-Omari B, Hone S, Russell, J. Transnasal endoscopic repair of choanal atresia in a tertiary care centre: A review of outcomes. Int J Ped Otorhinolaryngol 2012; 76:613-17.
http://dx.doi.org/10.1016/j.ijporl.2012.01.033
PMid:22418073
Bozkurt MK, Keles B, Azimov A, Ozturk K, Arbag, H. The use of adjunctive topical mitomycin in endoscopic congenital choanal atresia repair. Int J Ped Otorhinolaryngol 2010;74:733-36.
http://dx.doi.org/10.1016/j.ijporl.2010.03.026
PMid:20394996
Llorente JL, López F, Morato M, Suárez V, Coca A, Suárez C. Endoscopic treatment of choanal atresia. Acta Otorrinolaringol Esp. 2013;64(6):389-95.
http://dx.doi.org/10.1016/j.otorri.2013.05.001
http://dx.doi.org/10.1016/j.otoeng.2013.11.006
PMid:23896489
Hellín-Meseguer, D., Melgarejo-Moreno, P., Álvarez-Santacruz, C., Ghani, F., & Galindo-Ortego, J. (2016). Endoscopic surgery in a child with unilateral choanal atresia. Revista ORL, 7(1), 45–48. https://doi.org/10.14201/orl.13619
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