Surgical Management of Choanal Atresia

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Abstract
THE SURGICAL treatment of congenital choanal atresia is one of the more challenging endeavors within the realm of pediatric otolaryngology. The symptoms of choanal atresia largely depend on whether the condition is unilateral or bilateral; those with bilateral disease present early with life-threatening respiratory difficulty, whereas those with unilateral atresia may present in childhood or young adulthood with unilateral nasal obstruction and rhinorrhea. The atresia itself may be classified as bony, mixed bony and membranous, or purely membranous, although the latter may be rare.1 There are numerous methods for correcting this condition, but the current most commonly used methods are the transpalatal approach,2,3 the transseptal approach,4,5 and the endoscopic transnasal approach.6-8 Factors that influence the type of approach selected and its subsequent success include the age of the patient, the size of the nasopharynx, the thickness of the atresia, bilateral vs unilateral atresia, the use of postoperative stenting, the surgeon's preference of approach, and the presence of other anomalies such as found in the CHARGE association (a malformative syndrome that includes coloboma, hearing deficit, choanal atresia, retardation of growth, genital defects, and endocardial cushion defect).

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