Choanal atresia refers to a lack of formation of the choanal openings. It can be unilateral or bilateral. Epidemiology It frequently presents in neonates where it is . La atresia de coanas es una malformación congénita poco frecuente. Clásicamente se han descrito cuatro vías de abordaje para su corrección quirúrgica. A atresia de coanas é uma malformação congênita rara da cavidade nasal caracterizada pela obliteração completa da coana posterior. Nos 67% dos casos a.

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It has become an important tool to be kept up to date. The Journal publishes Original Articles articles on basic research and clinical investigationreviews, brief communications, case studies and images, which are subjected to a rigorous peer review process. CiteScore measures average citations received per document published.

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal’s impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. 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.

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.

Mixed bilateral choanal atresia was the most frequent 29 cases. Its incidence was higher in females 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 One patient died of causes unrelated ocanas the surgery. Two patients with permeable choanae remain with tracheotomy.

The transnasal microsurgical repair with endonasal stent proved to be a safe and effective procedure. Nueve pacientes presentaron complicaciones. Blockage of the nasal passages in newborns is a potentially fatal condition due to their necessarily nasal breathing.

The most common congenital causes are choanal atresia CAdermoid cyst, glioma, encephalocele and congenital stenosis of the piriform aperture.

CA is the most common congenital nasal anomaly. It is estimated that its incidence is 1 case per every —10 live births, 2 and it is more prevalent among females 2: Unilateral atresia is manifested as respiratory failure and unilateral rhinorrhea and may go unnoticed.

The diagnosis is suspected by the absence of airflow in the nostrils and inability of a nasogastric tube to advance, and is confirmed by nasal endoscopic examination and computed tomography CT scan of the atresix complex. In most cases, the plates are mixed bony and membranous componentsand less often, bony.

The definitive treatment is surgical, through various possible techniques and surgical approaches. Surgical repair with transnasal endoscopic technique provides an excellent visualisation of the posterior nasal defect and has currently become the procedure of choice due to its safety and effectiveness, displacing the transpalatine approach.

We describe our experience in the transnasal treatment of congenital CA using microscopy and placement of an intranasal stent.

We retrospectively evaluated 49 patients undergoing surgery for congenital CA at the Respiratory Endoscopy Service over a period of 20 years May —May The variables analysed were gender, location and type of atretic plate, age at diagnosis, associated malformations, maternal history of hyperthyroidism treated with methimazole during pregnancy, mode of airway stabilisation prior to surgery, age at surgery, surgical technique, duration of the nasal stent, need for other treatments, complications, follow-up time and evolution.


We performed a thorough prior assessment of coana by endoscopic examination of the nasal passages with a flexible fiberscope 2. All images were digitally documented. A total of 8 patients had undergone surgery previously at other coajas 7 cases of transnasal approach with an endoscope and 1 case of palatal approach. The surgical procedure consisted of a transnasal approach using microscopy.

Under general anaesthesia, after placing a gauze soaked in vasoconstrictor adrenaline 1: A protective gauze was placed in the nasopharynx. Following the bottom of the nasal fossa, the choana was opened medially and inferiorly. The incision of the mucosa was carried out with CO 2 laser 5 W continuous mode or cold instrumentation.

Once the nasal mucosa covering the atretic plate was removed, the plate and the posterior part of the vomer were extracted with microsurgical instrumentation ear curette or drill.

The edges of the neochoana were smoothed and the bone surface was covered with mucosa. All patients underwent placement of a silicone stent Foley probe number 12—18 as a support coanqs the intranasal lumen for 1—12 weeks. The time of removal of the coanaz tutor was based on laterality and type of atretic plate; it was shorter in unilateral CA and longer in bony plates.

In unilateral cases the tutor was placed on the affected side, fixed to the columella by a transfixing point. A Scheme of U-shaped nasal tutor for bilateral atresia. B Patient with tutor in position. From we began using topical mitomycin C 0. This was used in 14 patients atresoa In the immediate postoperative period, patients were admitted to the intermediate care ward, except for those who were intubated previously, who remained in the ICU until extubation at 24—72 h and were then transferred to intermediate care.

Extubation time was dependent on concomitant diseases, previous medication and clinical condition. They also received local postoperative treatment with nasal humidification and suction as required.

During the time the nasal tutor was maintained, patients underwent nasal washes with saline solution through the stent, aspiration of secretions as required and ed mupirocin to prevent lesions by decubitus position thereof. We performed weekly endoscopic controls during the first month after nasal stent extraction to evaluate the calibre of the neochoana and formation of granulation tissue.

Postoperative review was defined as any procedure under general anaesthesia conducted after the ccoanas intervention, including nasal stent removal and removal of granulation tissue with CO 2 laser or choanal dilatation with urethral catheters, with or without the use of topical mitomycin C, either to prevent restenosis or to improve choanal permeability.

The study included 30 female patients There were 3 pairs of affected sisters 1 pair of twins. The atretic plate was bilateral in 33 patients The most common plate was the mixed type 43 patients, Among the bilateral cases, A total of 7 patients All were females 2 of them were twin sisters and presented distinctive facial features: Patients with bilateral CA required stabilisation of the airway prior to surgery by endotracheal intubation in 14 cases The age range at the time of surgery was 3 days—13 years.

A total of Hospital discharge took place at 2 to 15 days after surgery, depending on the associated anomalies and where the patient lived. A total of 9 patients A total of 35 patients Patients who Required Postoperative Revisions. The mean follow-up time was 3. Adequate nasal ventilation was achieved in 46 patients CA is the most common congenital nasal anomaly characterised by the obliteration of the posterior nasal opening, due to the imperforation of the oronasal membrane and overgrowth of the horizontal and vertical process of the palatine bone during weeks 4—11 of the gestation process.

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Other theories about the origin of CA point to a persistence of the oropharyngeal membrane, incomplete reabsorption of the nasopharyngeal mesoderm and abnormal migration of neural crest cells. While the worldwide incidence of CA documented in the literature is 1 for every —10 live births, 2 in Argentina it is lower 1 per 70 live birthsgiven that there are atrezia live births per year and the annually reported cases of CA do not exceed It is more common among females and the most common type of atretic plate is the right unilateral.

The latter could be due to the fact that our service is a referral centre for infant airway disorders. The plates were mixed Depending on the type of atresia and age of the patient, the symptoms vary from mild respiratory distress with feeding to severe airway obstruction.

Choanal atresia – Wikipedia

While bilateral atresia is present at birth and represents a medical emergency, unilateral cases tend to appear between 5 and 24 months after birth. Due to their nasal breathing, newborns with bilateral CA present dyspnoea and cyanosis cyclically, which can be relieved with crying.

These cases require immediate ahresia of the airway and feeding through an orogastric tube. When CA is unilateral, sometimes the diagnosis takes place late during childhood or adolescence, manifesting as nasal obstruction and positional unilateral rhinorrhea increases by tilting the head forwardand occasionally as unilateral otitis media.

Choanal atresia

During the physical atresiia, anterior rhinoscopy reveals pale mucosa and turbinates in the affected nostril, as well as the presence of accumulated secretions which do not drain towards the nasopharynx. CA is suspected upon an absence of motion of a wisp of cotton or absence of fogging in a mirror placed under the nostrils while the mouth is closed, and also by impossibility of introducing an 8 French probe 2. The definitive diagnosis is obtained by endoscopic examination of the nasal fossae and CT scan of the craniofacial complex, with axial and coronal sections, showing coxnas type, thickness and location of the atretic plate, narrowing of the posterior nasal cavity and thickening of the vomer 3 Fig.

It also enables other possible sites of obstruction and anomalies of the nasopharynx and atrewia fossae to be excluded.

Computed tomography of the craniofacial complex. Types of choanal atresia. The differential diagnosis should consider stenosis of the piriform aperture, encephalocele, nasal tumours, such as gliomas and dermoid cysts, septal deviation and foreign bodies in unilateral casesamong other causes. Numerous malformations that are not part of coannas acronym have also been described in these children, including: CA would only play a role ahresia an aggravating factor in respiratory instability.

In 7 patients dee Some studies have shown that the use of certain antithyroid drugs methimazole, carbimazole during pregnancy may increase the risk of children being born with CA. Nevertheless, it is unknown whether the association is attributed to the medication, the maternal thyroid disease or abnormal levels of thyroid hormones in the newborn. It is thought that the maternal disease is the causal factor, rather than treatment with methimazole.

Patients with bilateral CA require expedited stabilisation of the airway, which can be achieved using a McGovern nipple, oral cannula atrexia endotracheal intubation. Tracheostomy is reserved for situations in which other craniofacial anomalies are associated.