Introduction:
Congenital bilateral choanal atresia is a pediatric emergency. Due to its rare incidence
(1/24,000) there are no consistent recommendations for surgical treatment and postoperative
management.
Methods:
Between 2002 and 2018, twenty patients with choanal atresia were surgically treated.
In case of bony stenosis the choanae were opened with a drill and a placeholder was
inserted in succession. Patients were followed up for approximately one year.
Results:
Eight patients suffered from bilateral choanal atresia and had to be treated surgically
within the first few days of life. Three other children were revised due to bilateral
re-stenosis after an initial operation performed alio loco. Nine operations were performed
for unilateral stenosis in childhood.
In non-syndromal children, discharge was possible within one week postoperatively.
Children were monitored at home by means of a home monitor, the placeholders were
cleaned with tacholiquin and aspirated three times a day by the parents. The placeholders
were usually left for 6 – 8 weeks. The suction incapacity of children with bilateral
choanal atresia could no longer be observed after removal of the placeholders.
Re-stenosis was seen in three cases, and occurred only in the group of newborns with
bilateral atresia with placeholders < 14 Charriere in size.
Conclusion:
The surgical opening of a choanal atresia with subsequent placeholder insertion and
adequate aftercare is a gentle and safe method, which largely avoids hospitalization
of the young patients. In order to further reduce the rate of re-stenoses a placeholder
of size greater than 14 Charriere should be used, and if this is not initially possible
one should consider changing the placeholder to a size 14 during the course of the
treatment.
