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Multicenter Study
. 2022 Jul 26;19(15):9084.
doi: 10.3390/ijerph19159084.

Endoscopic Endonasal Repair of Congenital Choanal Atresia: Predictive Factors of Surgical Stability and Healing Outcomes

Salvatore Ferlito  1 , Antonino Maniaci  1   2 , Alberto Giulio Dragonetti  3 , Salvatore Cocuzza  1 , Jerome Rene Lechien  2   4 , Christian Calvo-Henríquez  2   5 , Juan Maza-Solano  2   6 , Luca Giovanni Locatello  2   7 , Sebastiano Caruso  1 , Francesco Nocera  1 , Andrea Achena  3 , Niccolò Mevio  2 , Gabriella Mantini  3 , Giorgio Ormellese  3 , Angelo Placentino  3 , Ignazio La Mantia  1
Affiliations
Multicenter Study

Endoscopic Endonasal Repair of Congenital Choanal Atresia: Predictive Factors of Surgical Stability and Healing Outcomes

Salvatore Ferlito et al. Int J Environ Res Public Health. .

Abstract

Background: To assess the long-term outcomes and independent predictors of surgical success of a one-stage minimally invasive surgical procedure for congenital choanal atresia (C.C.A.). Methods: a retrospective multicentric study was conducted between 2010 and 2022. An endonasal endoscopic approach was performed in 38 unilateral or bilateral C.C.A. children. All the patients were clinically and radiologically assessed and followed for at least 2 years. Seven outcome measures were applied. Consequently, surgical success was correlated with all the independent variables reported. Results: 18/38 (47.36%) patients presented normal postoperative healing, 8/38 (21.05) had moderate restenosis (<50%), while 12/38 (31.57%) cases were severe (>50%), requiring a surgical revision. No statistical significance was found for average hospital stay between stenosis >50% and <50% patients (p = 0.802) and postoperative pain (p = 0.075); instead, the severe restenosis group demonstrated a higher delay of breast suction (p < 0.001). Among the independent variables predictors of surgical success, the presence of Charge syndrome and rhinopharyngeal stenosis demonstrated higher risks for surgical revision (OR: 4.00, 95% CI: 0.57−28.01, and OR: 2.75, 95% CI: 0.55−13.69, respectively). On the contrary, the hypoplastic inferior turbinate and bilateral C.C.A. showed a lower risk for severe restenosis by a higher endoscopic surgical space and creating a single larger opening (OR: 0.88, 95% CI: 0.22−3.52, and OR: 0.45, 95% CI: 0.10−2.08). Conclusion: Several independent variables could influence the surgical success after C.C.A. endoscopic repair; however, more high-quality evidence is needed to generate an effective predictive model.

Keywords: choanal atresia; endoscopic repair; long-term outcomes; surgical predictors; transnasal approach.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CONSORT 2010 Flow Diagram.
Figure 2
Figure 2
Post operative outcomes analysis divided for healing subtypes. In the Kruskal–Wallis test, a statistical significance was demonstrated only for delay in breast suction according to healing outcomes (p = 0.001).
Figure 3
Figure 3
Forest–plot of independent variables for surgical success.
Figure 4
Figure 4
Heatmap of Jaccard similarity coefficients matrix.
See this image and copyright information in PMC

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