Unilateral Choanal Atresia in a Child With Prolonged Nasal Congestion

Abstract

Choanal atresia obstructs the nasal passage due to abnormal bony or soft tissue remnants owing to the faulty canalization of the nasal passages during fetal development. The clinical manifestations are more pronounced in bilateral cases, often presenting immediately after birth with cyanosis turning pink when crying, as newborns are obligatory nasal breathers. This contrasts in unilateral cases, where the condition may present with mild symptoms and be diagnosed later in life. We present a case of a five-year-old male who initially presented with a concern for nasal polyps due to nasal congestion with absent airflow out of the right nostril. On examination of the pharynx and nose, the patient was diagnosed with nasal turbinate hypertrophy, the right more than the left, and was subsequently scheduled for bilateral inferior turbinate reduction, possible adenoidectomy, and nasal endoscopy. Intraoperatively, inspection with nasal endoscopy along with the inability to pass a catheter through the nasopharynx to reach the oropharynx was our indicator of a more severe diagnosis. Here, we report an incidental finding of the right choanal atresia and seek to highlight its importance given this incidental finding.

Keywords: choanal atresia; diagnosis; inferior turbinate hypertrophy; nasal congestion; right unilateral.

Figure 1. Posterior rhinoscopy visualizing the right unilateral choanal atresia (white arrow)

Figure 2. Retropalatal endoscopic view of the membranous unilateral choanal atresia (black arrow)

Source: [31] IT, interior turbinate; S, septum; ST, superior turbinate