We report on a male neonate with the very rare malformation of congenital midnasal
stenosis (MNS). Immediately postpartum the child developed paradoxical cyanosis with
recurrent cyanotic episodes in the near absence of nasal breathing. After exclusion
of the most common causes, such as choanal atresia and congenital stenosis of the
piriform aperture, the diagnosis of MNS was confirmed by nasal endoscopy and computed
tomography. Since conservative therapy by means of local decongestant nasal spray
and inhalations with epinephrine did not result in any improvement, surgical treatment
was performed. After a dilatation and a tamponade attempt, bougienage of the inferior
and middle nasal passages including the placement of bilateral stents made of modified
endotracheal tube were performed on the 17<sup>th</sup> day of life, which resulted
in sustained improvement of symptoms after an operative revision after 5 days. As
the symptomatology and the food intake improved markedly during the course, removal
of the nasal stents on day 37 of life revealed sufficient respiration and a persistent
quiet breathing pattern without signs of dyspnea. In the follow-up examination after
three months any respiratory abnormalities could not be observed. The infant was completely
orally fed and thrived adequately.
