title: Management of choanal atresia in cases of craniofacial malformation.
abstract: OBJECTIVE
  To report the method and results of endonasal endoscopic approach in congenital choanal atresia in cases of craniofacial malformation.
  
  
  METHODS
  The pathology of unilateral and bilateral choanal atresia and the treatment results in seven children treated between 1999 and 2006 are presented. 5 infants suffering from bilateral atresia also had severe malformations (Charge syndrome [2 patients], trisomy 18, microcephalus, central cranioschisis, cleft lip and anophthalmia 9). The surgical intervention was carried out immediately after birth. 2 patients with unilateral atresia were treated in their second and sixth year of life respectively. CT scan was the diagnostic procedure of choice. Intraoperative endoscopy showed both membraneous and osseous atresia.
  
  
  METHODS
  Trocars of different sizes were used to open the atresia plate, while the osseous parts were removed with diamond drills. Silicone tubes were inserted transnasally and remained in place for several months to improve the infants'ability to breath and drink.
  
  
  RESULTS
  In all cases of bilateral atresia the tubes either had to be changed repeatedly or replaced with larger tubes due to dislocation and head growth. The septum was perforated in one case. No further stenoses were detected following the removal of the tubes (after 3-6 months).
  
  
  CONCLUSIONS
  The transnasal access is particularly suited to newborns and infants because it induces a minor surgical trauma and carries a low risk of bleeding if endoscopes are used. The results show that the risk of restenoses can be minimised with sufficient fixating and in-patient care.
authors.affiliation: Department of Otolaryngology, Medical University of Hannover, Hannover, Germany  ; Department of Otolaryngology, Medical University of Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stieve
authors.forename: H G
authors.initials: HG
authors.lastname: Kempf
authors.forename: Th
authors.initials: T
authors.lastname: Lenarz
keywords: Choanal atresia; Craniofacial malformation; Surgical procedure