title: A 20-year experience in microsurgical treatment of choanal atresia.
abstract: OBJECTIVE
  Choanal atresia is the most common congenital nasal anomaly. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and different surgical techniques and approaches are used. We describe our experience in transnasal microsurgical treatment of congenital choanal atresia.
  
  
  METHODS
  We retrospectively evaluated 49 patients with congenital choanal atresia operated in the Department of Respiratory Endoscopy over a period of 20 years. The clinical variables analysed were type of atretic plate, age at diagnosis and surgery, associated malformations, maternal history of hyperthyroidism treated with methimazole during pregnancy, mode of airway stabilisation before surgery, surgical technique, complications, and outcome.
  
  
  RESULTS
  Mixed bilateral choanal atresia was the most frequent (29 cases). Its incidence was higher in females (61.2%). Almost 51% of patients showed associated malformations, and 7 had a history of maternal hyperthyroidism treated with methimazole during pregnancy. The surgical procedure consisted of a transnasal microscopic approach and placement of a silicone endonasal stent for one to 12 weeks. Thirty-five patients required revision after surgery. Nine patients had complications. Suitable nasal ventilation was achieved in 46 patients (93.9%). One patient died of causes unrelated to the surgery. Two patients with permeable choanae remain with tracheotomy.
  
  
  CONCLUSIONS
  The transnasal microsurgical repair with endonasal stent proved to be a safe and effective procedure.
authors.affiliation: Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodríguez
authors.affiliation: Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. Electronic address: giselle_cuestas@yahoo.com.ar.
authors.forename: Giselle
authors.initials: G
authors.lastname: Cuestas
authors.affiliation: Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Desiderio
authors.initials: D
authors.lastname: Passali
mesh_terms: D002754:Choanal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008866:Microsurgery / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors
keywords: Abordaje transnasal; Atresia de coanas; Choanal atresia; Congenital; Congénita; Microsurgical technique; Transnasal approach; Tratamiento microquirúrgico