Choanal Atresia

Epidemiology: Choanal atresia has an incidence of one in 5000 to one in 10,000 births and is more often unilateral than bilateral. The atresia is bony in 90% of cases and membranous in only 10%.
Symptoms: Bilateral choanal atresia is an acutely lifethreatening emergency because the neonate, except when crying, is an obligate nasal breather until about the sixth week of life. As a result, the infant experiences episodes of asphyxia at rest when its mouth is closed, especially during periods of sleep, and also during feeding. The resulting hypoxia is manifested by cyanosis, bradycardia, and an erratic respiratory rate with the mouth open or closed. Cyanosis that is present at rest and improves with exertion is called paradoxical cyanosis because of its opposite pattern relative to cyanosis with a cardiac cause. Unilateral choanal atresia may be manifested by a purulent nasal discharge on the affected side. Choanal atresia may be associated with various other anomalies, with fully developed cases presenting as the CHARGE syndrome ( coloboma; heart disease; atresia of the choanae; retarded growth, development and/or central nervous system anomalies; genital hypoplasia; ear
anomalies or deafness).
Diagnosis: Both choanae in newborns should be routinely catheterized in the immediate postnatal period (e.g., with the suction catheter) to exclude choanal atresia. The clinical suspicion of choanal atresia can be confirmed by examination with a rigid or flexible endoscope.
Treatment: The acute care of choanal atresia in asphyxia consists of intubation followed by
perforation of the atresia plate. Recurrent stenosis is prevented by inserting a stent and securing it with a suture (to prevent aspiration). The definitive surgical repair of bilateral choanal atresia is performed during the first weeks or months of life. Surgery for unilateral atresia can be postponed until school age, when the anatomy of the region is more similar to that encountered in adults.