Management of choanal atresia in the newborn

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Abstract
Bilateral congenital choanal atresia carries a high risk of brain damage due to hypoxia. Proper management requires early diagnosis, preferably in the delivery room, where temporary measures such as inserting an oral airway or a gavage tube are usually sufficient to establish satisfactory respiration. Careful observation is essential in the nursery during the period of local and general diagnostic evaluation to prevent repeated, even brief, spells of apnea. If satisfactory ventilation cannot be maintained, and particularly if there are associated serious anomalies, tracheotomy is indicated, rather than an immediate attempt to establish choanal patency.Definitive transnasal surgical correction can be accomplished during the neonatal period. Relatively non‐traumatic perforation of the obstruction with a probe or trocar, as reported by Hough in 1955, is followed by dilatation with appropriate metal sounds, and emplacement of non‐reactive plastic tubing.Excessive cicatrization, which is responsible for many failures of transnasal surgical methods, is further discouraged by the use of anti‐microbial agents to control infection in the choanal area. This can be expected to succeed in most cases if the tubing is maintained until healing is accomplished.

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