8.18 Choanal Atresia
Key Points
Choanal atresia occurs in ~ 1 in 5,000 to 8,000 births.
Bilateral atresia is more common and is associated with other anomalies (e.g., CHARGE association).
Endoscopic techniques have greatly improved the safety of the transnasal approach.
Choanal atresia is a congenital condition in which one or both of the choanae are replaced with a bony or mixed bony and membranous wall. Unilateral atresia usually presents later in life, while bilateral atresia is detected at birth. Bilateral atresia can often be medically managed with the use of a McGovern nipple while allowing growth in preparation for repair. The most common repair options include the transnasal and transpalatal approaches. The most frequent complication of repair is restenosis.
Epidemiology
Choanal atresia is relatively rare, only occurring in 1 in 5,000 to 8,000 births. It is almost twice as common in females as in males; 65 to 75% of cases are unilateral. The right choana is more commonly affected. Nearly 75% of bilateral atresias are associated with other disorders, including Treacher Collins′s syndrome, DiGeorge′s sequence, Apert′s syndrome, trisomy 18, and CHARGE association.
Clinical
Signs
Bilateral atresia will most often present in newborns with cyanotic spells relieved by crying and worsened with feeding. Unilateral atresia may present later in childhood with unilateral thick nasal secretions similar to sinusitis.
Symptoms
Bilateral disease will present at birth with difficulty breathing. Unilateral disease may present in older children and may be associated with history of nasal congestion.
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