Transnasal endoscopic treatment of bilateral choanal atresia in newborns using balloon dilatation: own results and review of literature.
OBJECTIVE
Congenital choanal atresia is a complete obliteration of the posterior nasal aperture leading to life-threatening airway emergencies. Several surgical options including sublabial, transpalatal, transseptal or external approaches have been developed for the repair of choanal atresia. So far, no gold standard has been established, but transnasal endoscopic approaches have been favored by many surgeons in recent years.


METHODS
Since 2008 a standard procedure for bilateral choanal atresia repair in neonates using an endoscopic transnasal approach supported by balloon dilatation has been established at the Department of Otorhinolaryngology at Ulm University Medical Center. During the last five years, six cases of bilateral choanal atresia were diagnosed and treated, including two male and four female patients aged between three days and two months, at the date of surgery. All interventions were performed in transnasal endoscopic technique. In all patients the abnormally thick posterior vomer and the atretic bony plate were resected and the mucosa was perforated. A balloon dilator was used to dilate the neochoanae and prevent restenosis. All six patients were intraoperatively stented for at least six weeks.


RESULTS
All six neonates with bilateral choanal atresia, who were operated in endoscopic transnasal technique had patent neo-choanae on both sides. No severe postoperative complications were found. The number of revisions depends on the age at primary surgery.


CONCLUSIONS
Endonasal endoscopic approach and balloon dilatation is a safe, reproducible technique for surgical repair of choanal atresia. We recommend the use of bilateral stents, especially in very young patients, as a prerequisite to prevent early restenosis.
Ulm University Medical Center, Department of Otorhinolaryngology, Frauensteige 12, 89075 Ulm, Germany. Electronic address: ricarda.riepl@uniklinik-ulm.de.
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Riepl
Ulm University Medical Center, Department of Otorhinolaryngology, Frauensteige 12, 89075 Ulm, Germany. Electronic address: marc.scheithauer@uniklinik-ulm.de.
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Scheithauer
Ulm University Medical Center, Department of Otorhinolaryngology, Frauensteige 12, 89075 Ulm, Germany. Electronic address: t.hoffmann@uniklinik-ulm.de.
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Hoffmann
Ulm University Medical Center, Department of Otorhinolaryngology, Frauensteige 12, 89075 Ulm, Germany. Electronic address: nicole.rotter@uniklinik-ulm.de.
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Rotter
D002754:Choanal Atresia / Q000601:surgery*; D004106:Dilatation / Q000295:instrumentation* / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009296:Nasal Cavity; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D012494:Sampling Studies; D015607:Stents; D016896:Treatment Outcome
Balloon dilatation; Choanal atresia; Restenosis; Transnasal endoscopic approach