[Choanal atresia: therapeutic management and results]

Abstract

Objectives: To assess and compare long term results after surgical correction (transnasal or transplatine approaches) of unilateral or bilateral choanal atresia, in children with or without associated anomalies.

Patients: During a 13-year period, 58 children were included in this retrospective study. Seventy-five choanas were operated on (41 unilateral and 17 bilateral). The transpalatine approach was performed in 41 children (56 choanas) while the transnasal approach was performed in 17 patients (19 choanas). Associated anomalies were reported in 28 children and corresponded to CHARGE association in 13 cases.

Results: With a mean follow-up of 7 years, perfect choanal permeability was reported in 90% of children operated on through a transpalatine approach and in 76% of children with a transnasal approach. A complementary therapeutic procedure was required in 54% of transpalatine approaches and 46% of transnasal approaches to yield these results. Postoperative choanal permeability was obtained in 93% of children without an associated anomaly and in 77% of those with associated anomalies, such as in 88% of unilateral atresias and 80% of bilateral ones.

Conclusion: Initial success rate after surgery is similar for all surgical procedure insofar as nearly half choanas required a complementary therapeutic procedure. The endonasal procedure using the microdebrider appears hopeful and the KTP laser is interesting in fibrous residual stenosis. Associated anomalies are factors which lower general prognosis while inducing a higher surgical failure rate.