[Combined transseptal-transnasal surgery of unilateral choanal atresia without using stents]

Abstract

Background: This is a report of a surgical procedure with which stenting after surgery of unilateral choanal atresia can be avoided.

Method: We start transseptally with a hemitransfixion incision. The vomer and the bony atresia plate are dissected submucosally and then resected with punches and a diamond burr, whilst the nasal and the pharyngeal mucosa of the atresia is preserved completely. The next step is to cut transnasally a door-like flap out of the nasal blade of the mucosa of the atresia, that is based laterally and with which the lateral raw surface of the new choana will be covered. Now a medially based door-like flap is cut out of the up to now intact pharyngeal blade of the atresia, with which the medial wound surface is to be covered. The flaps are fixed with fibrin glue and with a nasal tamponade for two days, as after septoplasty. It is not necessary to insert stents anymore.

Results: Between 1995 until 1998 we treated three female and two male patients using this method. Their ages were 6, 17, 17, 20 and 35 years and the postoperative observation lasted 2, 4, 1, 3 and 3 years. A restenosis was not seen in any of the cases.

Conclusion: Because of these results, it is recommended to treat unilateral choanal atresias of adults and children older than five years by using a combined transseptal-transnasal procedure. By using the described surgical technique postoperative stenting can be avoided.