Endoscopic Repair of Choanal Atresia: 33 Years Later

Endoscopic repair of choanal atresia was first described in 1990. ¹ It is now the preferred surgery treatment for choanal atresia/stenosis. In 1987, the senior author performed the procedure on a newborn in respiratory distress. The surgery was successful. Thirty-three years later, the now grown woman was seen in clinic for nasal congestion. Although her current problem was related to rhinitis and turbinate hypertrophy, her visit also served as an opportunity to witness the healing from surgery 33 years ago. Endoscopic photos were obtained and are presented.

Her past history revealed in 1987, shortly after birth, she developed respiratory distress and required intubation. A diagnosis was made of choanal atresia on inability to pass a nasal catheter, and choanal atresia was confirmed on computed tomography scan (Figure 1). The author took the infant to surgery and confirmed choanal atresia on endoscopic examination (Figure 2). Endoscopic correction was then performed. According to the operative note, a superior-based mucosal flap was created on each side. Bony atresia was removed with punch forceps and curettes. The posterior end of the septum was removed with backward biting punch forceps (Figure 3). A U-shaped stent using a small pediatric endotracheal tube was fashioned and sutured anteriorly to the septum. The stent was removed in 1 month without a septal perforation.

Figure 1.

Axial computed tomography (CT) scan sinuses showing bilateral choanal atresia preop.

Figure 2.

Endoscopic view of choanal atresia preop.

Figure 3.

Postop view of choanal atresia one month after endoscopic repair surgery at second look for stent removal.

Thirty-three years later, the endoscopic examination showed a wide-open choana with a posterior septal perforation. Of interest, the mid to posterior inferior turbinates were hypertrophic and almost touching through the posterior perforation (Figure 4). Inferior turbinate reduction opened her nasal airway and relieved her congestion.

Figure 4.

Endoscopic view of choanal atresia repair 33 years postop.

It is important based on this case to think about what we do in choanal atresia surgery today and how it can affect a patient many years later. Looking back on the initial surgery, probably too much septum was removed (Figures 3 and 4). In an infant, removal of a centimeter or more of the posterior septum is easy to do but has to be limited. The septum is not that long in an infant, perhaps 3 to 4 centimeters. Too much can be removed with ease! However, for the surgery to be successful, the posterior septum does require limited removal. The author was happily surprised at how open the nose and choana were 30 years later! A very good result!