Choanal Atresia Overview and Management

Choanal Atresia Definition and Incidence

• Rare condition affecting 1 in 7000 live births.
• Complete obstruction of posterior choanae (one or both sides).
• Blockage usually mixed bony and membranous (70%), sometimes purely bony.
• Results from persistence of bucco-nasal membrane.

Bilateral Choanal Atresia in Neonates

• Causes acute respiratory distress (obligate nasal breathers).
• Presents as cyclical cyanosis relieved by crying.
• Oral airway placement resolves distress.

Unilateral Choanal Atresia

• May present later in life.
• Difficulty passing nasogastric tube through affected nasal passage.
• Neonates may have feeding difficulties.

Diagnosis of Choanal Atresia

• Misting on placing a metal spatula under the nostrils excludes atresia.
• Failure to pass a 5 or 6 French size tube indicates atresia.
• Flexible nasendoscopy confirms diagnosis.
• CT scan determines extent and nature of atresia.

Surgical Management of Choanal Atresia

• Transnasal and transpalatal approaches are common.
• Similar outcomes reported for both techniques.
• Transpalatal less common now, useful in craniofacial anomalies.

Endoscopic Transnasal Approach

• Two methods exist:
  • Zero-degree endoscope transnasally with serial dilations (urethral dilators or microdrills).
  • 120-degree endoscope via mouth, positioned in nasopharynx, viewing postnasal space.

This quiz explores the definition, incidence, and different types of choanal atresia. It covers diagnostic methods, symptoms, and surgical management options for this rare condition affecting neonates. Test your knowledge on this critical topic in pediatric medicine.