A Stentless Choanoplasty for Bilateral Congenital Choanal Atresia: Endoscopic Submucous Resection of Posterior Septum

Abstract

Article information Aim of the work: To evaluate the submucosal resection of the posterior part of septum in the management of bilateral congenital choanal atresia. Patients and Methods: seventeen new-born infants with bilateral congenital choanal atresia were managed endoscopically by a transnasal repair together with submucosal resection of the posterior part of the septum. On CT scan, 14 infants had mixed atresia, and 3 infants had pure bony atresia. Using a 2.7 mm, 0° sinuscope, the site of the atretic plate and the adjacent part of the posterior septum were infiltrated. A vertical incision was taken at the bony cartilaginous junction of the septum using a round/sickle knife. The bony septum was drilled out along with the atretic plates of both sides. The two septal mucoperiosteal flaps were then approximated and the soft tissue that was occluding the choana was then excised on both sides. The remaining bones of the atretic plates were then removed from the remaining superior, lateral and inferior walls to widen the neo-choana and create a wider than normal choana Results: A follow-up period for at least one year, revealed that 10 cases remained patent for adequate size bilaterally, four cases were found with bilateral concentric narrowing but still adequate for breathing, one case required revision surgery of the right side, two cases required bilateral revision surgery. Conclusion: Endoscopic submucous resection of the posterior part of the septum for the repairing of bilateral choanal atresia meets the goals of efficacy and safety, and diminished incidence of restenosis.