Clinical retrospective analysis of 15 cases of choanal atresia – Our experience

OBJECTIVE: Choanal atresia is a rare congenital disorder due to failed recanalization of the nasal fossae during fetal development. This article focuses on our experience in dealing with choanal atresia and its management. Here we discuss the varied clinical symptoms that the patients presented with, the clinical tests and investigations that were specific in diagnosing this condition and surgical management of these cases with endoscopic transnasal choanaplasty with stenting and follow up topical Mitomycin C application. MATERIAL AND METHODS: This is a retrospective study based on computerized medical record review of the patients born in Department of ENT of Sur Hospital between 2002 and 2017. The patients were assessed with detailed history, presentation of clinical symptoms and all underwent nasal endoscopy and CT scans for assessing the atretic type. These patients underwent transnasal endoscopic choanaplasty under general anesthesia using microdebrider and stented using endotracheal tube. The patients were regularly followed up for review with nasal endoscopy after discharge between 4th and 7th postoperative period. The parents were educated on nursing care and the stent was removed in 4 weeks, all patients had Mitomycin C applied to the neochoana and were on regular follow up for a year with no recurrence. RESULTS: Fifteen patient records were analyzed, 10 females and 5 males, ages varying from newborns up to 14 years old. Unilateral to bilateral choanal atresia was 4:1 ratio and female-male showed 2:1 ratio. Right malformation was predominant in both sexes in unilateral atresia. Mixed imperforation (bone-membranous) was the most frequently observed type, followed by bone malformation. The commonest symptom during diagnosis was rhinorrhea and the least one was respiratory failure. Majority of cases were diagnosed by CT scans of sinuses. Around 10% patients presented with cardiac problems. None had restenosis in one year follow up. CONCLUSIONS: Neonates with acute respiratory insufficiency due to choanal atresia can be diagnosed with simple bedside tests like cold spatula test, less invasive tests like failure to pass intranasal catheter, CT scan. Surgical correction with endoscopic intranasal choanaplasty is the way to address this problem and could avoid radical palatal approach, less morbidity and high success rate.