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Surgical Management of Choanal Atresia

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All Around the Nose

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Abstract

Death from asphyxia may occur in neonate babies due to complete nasal obstruction. The tongue is pulled towards the palate during inspiration, this results in occlusion of the oral airway. Strenuous attempts at breathing show marked chest retractions. If relevant attempts at treatment are not provided there is an increased risk of cyanosis, which may result in death. However if the newborn cries and breathes through its mouth the obstruction of the airway is temporarily alleviated. When the infant stops crying, the mouth will once again close and the sequence of oral obstruction is thus repeated. Choanal atresia is seen at an average of 0.82% for every 10,000 births. Unilateral atresia is most commonly experienced on the right side. A ratio of 2:1 is observed in unilateral to bilateral cases with a slightly heightened risk in twin newborns. The mother’s age or parity does not raise the frequency of incidents. Six percent of newborns diagnosed with choanal atresia are noted to have chromosomal abnormalities, while it was found that 5% of the infants have monogenic syndromes or conditions. The most fundamental challenge and worry in a newborn afflicted with choanal atresia, especially bilateral choanal atresia, is that for between 4 and 6 weeks after birth newborns are obligatory nasal breathers. In this chapter, surgical management of choanal atresia is discussed.

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References

  1. Tewfik TL. Choanal atresia. In: Meyers AD, editor. Medscape. http://emedicine.medscape.com/article/872409-overview#showall. Accessed 24 Apr 2016.

  2. Michalski AM, Richardson SD, Browne ML, et al. Sex ratios among infants with birth defects, National Birth Defects Prevention Study, 1997–2009. Am J Med Genet A. 2015;167A(5):1071–81.

    Article  Google Scholar 

  3. Kwong KM. Current updates on Choanal Atresia. Front Pediatr. 2015;3:52.

    Article  Google Scholar 

  4. Barbero P, Valdez R, Rodríguez H, et al. Choanal atresia associated with maternal hyperthyroidism treated with methimazole: a case-control study. Am J Med Genet A. 2008;146A(18):2390–5.

    Article  Google Scholar 

  5. Lee LJ, Canfield MA, Hashmi SS, Moffitt KB, Marengo L, Agopian AJ, et al. Association between thyroxine levels at birth and choanal atresia or stenosis among infants in Texas, 2004–2007. Birth Defects Res A Clin Mol Teratol. 2012;94(11):951–4.

    Article  CAS  Google Scholar 

  6. Kancherla V, Romitti PA, Sun L, et al. Descriptive and risk factor analysis for choanal atresia: The National Birth Defects Prevention Study, 1997–2007. Eur J Med Genet. 2014;57(5):220–9.

    Article  Google Scholar 

  7. Yantis M, Mukerji S, Pine H. Choanal atresia: diagnosis, management, and association with CHARGE syndrome. In: Quinn FB, editor. Grand Rounds Presentation, Department of Otolaryngology, The University of Texas Medical Branch (UTMB Health), 2014. http://www.utmb.edu/otoref/GRNDS/2014-01-27-choananal-atresia-Yantis-ok/choanal-atresia-2014-01-b.pdf. Accessed 24 Apr 2016.

  8. Cedin AC, Atallah AN, Andriolo RB, Cruz OL, Pignatari SN. Surgery for congenital choanal atresia. Cochrane Database Syst Rev. 2012;2:CD008993. https://doi.org/10.1002/14651858.CD008993.pub2.

    Article  Google Scholar 

  9. Emmert C. Stenochorie und Atresie der Choannen, Lehrbach der Speciellen Chirurgie, vol. 2. Stuttgart: Dann; 1854. p. 535–8.

    Google Scholar 

  10. Gujrathi CS, Daniel SJ, James AL, Forte V. Management of bilateral choanal atresia in the neonate: an institutional review. Int J Pediatr Otorhinolaryngol. 2004;68(4):399–407.

    Article  CAS  Google Scholar 

  11. Park AH, Brockenbrough J, Stankiewicz J. Endoscopic versus traditional approaches to choanal atresia. Otolaryngol Clin North Am. 2000;33(1):77–90.

    Article  CAS  Google Scholar 

  12. Hengerer AS, Brickman TM, Jeyakumar A. Choanal atresia: embryologic analysis and evolution of treatment, a 30-year experience. Laryngoscope. 2008;118(5):862–6.

    Article  Google Scholar 

  13. Stieve M, Kempf HG, Lenarz T. Management of choanal atresia in cases of craniofacial malformation. J Maxillofac Oral Surg. 2009;8(1):52–4.

    Article  Google Scholar 

  14. Stankiewicz JA. The endoscopic repair of choanal atresia. Otolaryngol Head Neck Surg. 1990;103(6):931–7.

    Article  CAS  Google Scholar 

  15. Assanasen P, Metheetrairut C. Choanal atresia. J Med Assoc Thail. 2009;92(5):699–706.

    Google Scholar 

  16. Ibrahim AA, Magdy EA, Hassab MH. Endoscopic choanoplasty without stenting for congenital choanal atresia repair. Int J Pediatr Otorhinolaryngol. 2010;74(2):144–50.

    Article  Google Scholar 

  17. Rodriguez H, Cuestas G, Passali D. A 20-year experience in microsurgical treatment of choanal atresia. Acta Otorrinolaringol Esp. 2014;65(2):85–92.

    Article  Google Scholar 

  18. El-Ahl MA, El-Anwar MW. Stentless endoscopic transnasal repair of bilateral choanal atresia starting with resection of vomer. Int J Pediatr Otorhinolaryngol. 2012;76(7):1002–6.

    Article  Google Scholar 

  19. Asma A, Roslenda AR, Suraya A, Saraiza AB, Aini AA. Management of congenital choanal atresia (CCA) after multiple failures: a case report. Med J Malaysia. 2013;68(1):76–8.

    CAS  PubMed  Google Scholar 

  20. Teissier N, Kaguelidou F, Couloigner V, Francois M, Van Den Abbeele T. Predictive factors for success after transnasal endoscopic treatment of choanal atresia. Arch Otolaryngol Head Neck Surg. 2008;134(1):57–61.

    Article  Google Scholar 

  21. Newman JR, Harmon P, Shirley WP, Hill JS, Woolley AL, Wiatrak BJ. Operative management of choanal atresia: a 15-year experience. JAMA Otolaryngol Head Neck Surg. 2013;139(1):71–5.

    Article  Google Scholar 

  22. Kim H, Park JH, Chung H, Han DH, Kim DY, Lee CH, et al. Clinical features and surgical outcomes of congenital choanal atresia: factors influencing success from 20-year review in an institute. Am J Otolaryngol. 2012;33(3):308–12.

    Article  Google Scholar 

  23. Corrales CE, Koltai PJ. Choanal atresia: current concepts and controversies. Curr Opin Otolaryngol Head Neck Surg. 2009;17(6):466–70.

    Article  Google Scholar 

  24. Durmaz A, Tosun F, Yldrm N, Sahan M, Kvrakdal C, Gerek M. Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. J Craniofac Surg. 2008;19(5):1270–4.

    Article  Google Scholar 

  25. Velegrakis S, Mantsopoulos K, Iro H, Zenk J. Long-term outcomes of endonasal surgery for choanal atresia: 28 years experience in an academic medical centre. Eur Arch Otorhinolaryngol. 2013;270(1):113–6.

    Article  Google Scholar 

  26. Bedwell JR, Choi SS. Are stents necessary after choanal atresia repair? Laryngoscope. 2012;122(11):2365–6.

    Article  Google Scholar 

  27. Schoem SR. Transnasal endoscopic repair of choanal atresia: why stent? Otolaryngol Head Neck Surg. 2004;131(4):362–6.

    Article  Google Scholar 

  28. Carter JM, Lawlor C, Guarisco JL. The efficacy of mitomycin and stenting in choanal atresia repair: a 20 year experience. Int J Pediatr Otorhinolaryngol. 2014;78(2):307–11.

    Article  Google Scholar 

  29. Agrawal N, Morrison GA. Laryngeal cancer after topical mitomycin C application. J Laryngol Otol. 2006;120(12):1075–6.

    Article  CAS  Google Scholar 

  30. Healy GB, McGill T, Jako GJ, Strong MS, Vaughan CW. Management of choanal atresia with the carbon dioxide laser. Ann Otol Rhinol Laryngol. 1978;87(5 Pt 1):658–62.

    Article  CAS  Google Scholar 

  31. Fong M, Clarke K, Cron C. Clinical applications of the holmium: YAG laser in disorders of the paediatric airway. J Otolaryngol. 1999;28(6):337–43.

    CAS  PubMed  Google Scholar 

  32. Lapointe A, Giguère CM, Forest VI, Quintal MC. Treatment of bilateral choanal atresia in the premature infant. Int J Pediatr Otorhinolaryngol. 2008;72(5):715–8.

    Article  Google Scholar 

  33. D’Eredità R, Lens MB. Contact-diode laser repair of bony choanal atresia: a preliminary report. Int J Pediatr Otorhinolaryngol. 2008;72(5):625–8.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Acıbadem Mehmet Ali Aydınlar Medical Faculty, İstanbul, Turkey

    İsmet Emrah Emre

  2. Department of Otorhinolaryngology, Medical Faculty, Kırıkkale University, Kırıkkale, Turkey

    Nuray Bayar Muluk

  3. Clinic for Otorhinolaryngology, University Clinical Center Nis, Niš, Serbia

    Milan Stankovic

Authors
  1. İsmet Emrah Emre
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  2. Nuray Bayar Muluk
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  3. Milan Stankovic
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Editor information

Editors and Affiliations

  1. Eskişehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey

    Cemal Cingi

  2. Department of Otorhinolaryngology, Medical Faculty, Kirikkale University, Kirikkale, Turkey

    Nuray Bayar Muluk

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Emre, İ.E., Bayar Muluk, N., Stankovic, M. (2020). Surgical Management of Choanal Atresia. In: Cingi, C., Bayar Muluk, N. (eds) All Around the Nose. Springer, Cham. https://doi.org/10.1007/978-3-030-21217-9_57

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  • DOI: https://doi.org/10.1007/978-3-030-21217-9_57

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21216-2

  • Online ISBN: 978-3-030-21217-9

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