Endoscopic bilateral congenital choanal atresia repair of 112 cases, evolving concept and technical experience

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• 作者：Hesham Mohammad Eladl ; ^{meheladl@yahoo.ca" class="auth_mail" title="E-mail the corresponding author} ; ^{heshameladl@mans.edu.eg" class="auth_mail" title="E-mail the corresponding author} ; Yasser W. Khafagy
• 关键词：Endoscopic sinus surgery ; Choana ; Atresia ; Sinus ; Transnasal ; Choanal
• 刊名：International Journal of Pediatric Otorhinolaryngology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：85
• 期：Complete
• 页码：40-45
• 全文大小：1453 K

文摘

This study aims to present 18 years’ experience with endoscopic treatment of bilateral congenital choanal atresia as regard to management concept, surgical technique, results, pitfalls, and complications.

Patients and methods

A retrospective study including 112 cases of bilateral congenital choanal atresia, treated at Mansoura University Hospital endoscopically in the period from January 1998 to March 2015. As far as we know, this is the largest study group on transnasal endoscopic choanal atresia repair in literature.

Results

One hundred and twelve infants (87 females, 25 males) were included in the study. Age at operation ranged between 1 day and 28 days (8.75 days in average), and body weight average was 2.76 kg. All patients were diagnosed at birth except 3 infants. In this study, 85 cases were mixed atresia, 25 cases were bony atresia, and only two cases were membranous. In all cases, obliterated choana bone and vomer bone was removed, lateral wall drilling was used in 33 cases. Follow up ranged between 6 months and 18 years (95.6 months in average). The most common complication was restenosis, occurred in 42% (47 cases). Second-look procedure was done in 68 cases. The need for second-look evaluation with stent group was 74.5% (62 out of 83 infants), whereas in non-stent group was 20.6% (6 out of 29 infants).

Conclusion

Endoscopic repair of bilateral choanal atresia is a safe, effective technique with minimal complication. Usage of 30 degree sinuscope permits better visualization and higher accessibility for the surgical instruments. Surgically formed wide single neochoana with removal of all intervening tissue surroundings, and good follow up permit higher success rate without stenting. Advanced learning curve permits tailoring the perfect surgery with minimal tissue injury and better outcome. Post-operative choanal dilatation using esophageal dilators under endoscopic examination decrease the need for stenting and second-look evaluation.