Surgical Timing and Stenting in Neonatal Choanal Atresia

Abstract

Background and objectives: Congenital choanal atresia is a rare condition that occurs in approximately 1 in 7,000 to 8,000 live births and involves the obstruction of the posterior nasal airway. It may present as either unilateral or bilateral, with bilateral cases being more severe due to the risk of immediate neonatal respiratory distress. Bilateral congenital choanal atresia (BCCA) necessitates prompt medical intervention to prevent cyanosis and significant breathing difficulties. This study focuses on the timing of surgery, the duration of stent use, and postoperative care in patients with bilateral congenital choanal atresia who underwent endoscopic transnasal surgery. Unlike previous studies, this research emphasizes the efficacy of an extended stenting period and introduces novel stenting techniques aimed at reducing restenosis.

Methods: From 2018 to 2021, three patients with BCCA underwent transnasal surgery that included the placement of stents. We retrospectively analyzed their medical records, focusing on the surgical outcomes in relation to the duration of stent placement and postoperative care. A novel approach was adopted, involving the use of customized stent sizes tailored to the specific anatomical factors of each patient, which facilitated improved neochoana maintenance.

Results: The average interval from diagnosis to surgery was 3.6 weeks. Surgery was successful in all cases, and the stent was removed after 6 months. In all patients, stable neochoanae were maintained without significant restenosis. Additionally, we observed that maintaining a stent for a period longer than previously recommended significantly reduced the risk of restenosis compared to the shorter durations used in earlier studies.

Conclusion: Our study suggests that an extended stenting period of 6 months or more is crucial for maintaining long-term patency in patients with BCCA. This approach could lead to a more reliable stenting protocol and improved postoperative care, potentially establishing a new standard for managing BCCA.

Keywords: Atresia; Choanal atresia; Endoscopy; Nasopharynx; Transnasal.

Fig. 1.

Intraoperative endoscopic views of opening of choanal atresia. A: Central perforation of the left obliterated choana by suction tube. B: Make a hole in the lower, inner part of the atretic plate using a curette. C: Opened choanal atresia after laterally drilling the medial pterygoid plates. D: Insert intubation tube (*) as a stent.

Fig. 2.

Intraoperative views of inserting the stent. A: Nelaton catheter was inserted through the nasal cavity to make the pathway. B: Nelaton tube connected with nylon 3-0 is inserted into the nostril, passed through the neochoana, and then withdrawn through the mouth. C: Removing the catheter and putting an intubation tube to act as a stent for the newly made passage.

Fig. 3.

Preoperative evaluations using mirror (A) and endoscopic view of nasal cavity (B). Endoscopy shows a membranous atretic plate at choana. IT, inferior turbinate; S, septum.

Fig. 4.

Preoperative CT. Axial views of bilateral atretic plate of mixed bony/membranous component (A) and bony component (B) are shown.

Fig. 5.

Postoperative endoscopic view at 1 year follow-up in Case 1. A: Left neochoana. B: Right neochoana.