Choanal Atresia

The choanae are the openings that connect the nasal cavities to the nasopharynx. Choanal atresia is a condition in which these openings are blocked by bone, soft tissue, or a combination of both. This blockage can be present in one or both nostrils.

Choanal atresia occurs in 1 in 7,000 to 8,000 live births. If only one nostril is blocked (unilateral choanal atresia), it may not cause any problems. This is because the other nostril is usually open and allows the baby to breathe normally. However, if both nostrils are blocked (bilateral choanal atresia), the baby will not be able to breathe and will need to be intubated (a tube is inserted through the mouth into the trachea and connected to a ventilator). In this situation, the baby needs surgery to open the choanae as soon as possible.

How is choanal atresia diagnosed?

Newborn babies are routinely examined for choanal atresia. During this examination, a small catheter is inserted into each nostril to check the airways. If the catheter cannot be passed through, choanal atresia is suspected. In this case, an ENT doctor will perform a detailed examination and order radiological tests to confirm the diagnosis of unilateral or bilateral choanal atresia.

How is choanal atresia treated?

The treatment for choanal atresia is surgery. If both nostrils are blocked, surgery is urgently needed. If only one nostril is blocked, surgery is not an emergency and can be delayed until the child is older. In general, it is recommended that surgery to open the blocked nostril be performed before the child reaches school age.

The most common surgical technique used today is endoscopic choanal atresia repair. In this surgery, no incisions are made. Instead, an endoscope is inserted into each nostril to open the atretic area. Stents are usually placed in the nostrils during surgery. These stents are removed 2-4 weeks later in an operating room setting. The patient is then closely monitored.

Post-operative care for choanal atresia surgery

If stents are used, antibiotics, nasal sprays, and moisturizing creams for the nostrils may be needed. After surgical repair of choanal atresia, patients may need debridement or dilation of the surgical site. These procedures are usually performed under general anesthesia on young infants and children.