J Neurol Surg B Skull Base 2022; 83(03): 223-227
DOI: 10.1055/s-0040-1722230
Original Article

Skull Base Anatomy in Patients with Bilateral Choanal Atresia: A Radiographic Study

1   Department of Otolaryngology – Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
Einat Slonimsky
2   Department of Radiology, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
Roshan Nayak
3   Ichan School of Medicine at Mount Sinai, New York, New York, United States
Lisa Engle
4   Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
Junjia Zhu
4   Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
Meghan Wilson
1   Department of Otolaryngology – Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
› Author Affiliations
Funding There are no financial disclosures for any author.


Introduction The risk of skull base injury during choanal atresia repair can be mitigated via thorough understanding of skull base anatomy. There is a paucity of data describing differences in skull base anatomy between patients with coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities (CHARGE) syndrome and those without.

Objectives The aim of this study was to measure nasal and skull base anatomy in patients with isolated bilateral choanal atresia (BCA), CHARGE syndrome, and other syndromic congenital anomalies.

Methods Retrospective chart review of patients with bilateral choanal atresia and computed tomography of the face between 2001 and 2019 were evaluated. Choanal width, height, mid-nasal height, and skull base slope were measured radiographically. Differences in anatomy between healthy patients, those with CHARGE syndrome, and those with other congenital anomalies were compared.

Results Twenty-one patients with BCA and relevant imaging were identified: 7 with isolated BCA, 6 with CHARGE syndrome, and 8 with other congenital anomalies. A t-test indicated insignificant difference in skull base slope, choanal height, choanal width, or mid-nasal skull base height between isolate BCA cases and patients with any congenital anomaly. When comparing CHARGE to isolated BCA cases, mid-nasal height was shorter in CHARGE patients (p = 0.03). There were no differences in measurements between patients with congenital anomalies excluding CHARGE (p > 0.05). Two patients in the congenital anomaly group were found to have bony skull base defects preoperatively.

Conclusion This study represents the largest description of skull base and nasal anatomy in patients with CHARGE syndrome and BCA. Surgeons should be aware of the lower skull base in CHARGE patients to avoid inadvertent skull base injury.


This paper was presented as a poster presentation at the North American Skull Base Society Meeting on February 8, 2020 in San Antonio, Texas.

Publication History

Received: 08 April 2020

Accepted: 05 October 2020

Article published online:
04 February 2021

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