Endoscopic Choanal Atresia Repair
Choanal atresia is a congential defect of the nasal cavity. It involves a blockage in the choana, which are the passages of the nasal cavity, and results in breathing difficulties. Choanal atresia is present at birth and it is considered a relatively rare anomaly. Unilateral choanal atresia, in which only one side of the nasal passage is narrowed, is more common than the bilateral form of this condition, which can be fatal in infants because both nasal passages are blocked. The obstruction may be composed completely of either tissue or bone, but is typically a combination of bone and tissue growth.
The exact cause of choanal atresia is unknown, although the majority of patients with this condition also have other developmental disorders present at birth. It is believed that it may result from a misstep during the fetal development stage. Tissue between the nose and mouth that is normally present at that point remains fixed in place and causes a blockage. Choanal atresia tends to affect females more frequently than males.
Symptoms of Choanal Atresia
Common symptoms of choanal atresia include highly audible respiration and recurrent breathing difficulties that are relieved by stretches of crying. Since newborns breathe mainly through their noses, those with choanal atresia do not generally receive an adequate supply of air until they begin to cry. Crying improves the situation because that is the only time infants primarily breathe through their mouths. In addition, many children with choanal atresia experience excessive drainage from the nose and have trouble nursing normally.
The symptoms are more immediate and more pronounced in infants with bilateral choanal atresia. They may turn a bluish color and have sunken chests until they begin crying and restore air flow. Therefore, patients with bilateral choanal atresia are usually diagnosed shortly after birth due to their extreme respiratory distress. Those with unilateral choanal atresia may not become obviously symptomatic until months or years later because they can successfully breathe through one nasal passage.
The diagnosis is confirmed through CT scans and sometimes endoscopy that provide images of the nasal cavity.
Treatment of Choanal Atresia
Mild cases of unilateral choanal atresia that do not seriously impact breathing may only necessitate monitoring of the condition and regular saline use to keep the normal passageway moist and clear. In more severe cases, as well as all cases of bilateral choanal atresia, surgery is required to open the nasal passages. Surgical repair is the only treatment available to repair the blocked airway.
Endoscopic repair of choanal atresia is the standard, most effective method of treatment used today. It improves on traditional open procedures because it is less invasive, making the recovery process faster and more comfortable. This surgery is performed while the patient is under general anesthesia. The most common approach taken to reach the blocked airway is through the nostrils, called a transnasal approach. Typically the alternate method, called a transpalatal approach since the incision is made in the roof of the mouth, is only used in certain circumstances when it is anatomically necessary. Using either approach, the procedure generally lasts for one to two hours.
After the anesthesia has taken effect, tiny incisions are made. The surgeon inserts an endoscope, which is a thin, flexible tube containing a light and camera to provide visualization of the area. Small surgical instruments are then inserted too. Depending on the cause of the narrowing, a dilator may be used to widen the passage or tools may be necessary to shave the surrounding bone and tissue down. In some cases, a stent must be placed in the airway to hold it open during the healing process. The stent is then removed several weeks later once the stability of the opening has been established.
Recovery from Endoscopic Choanal Atresia Repair
After the surgery, the patient will typically remain in the hospital for one to three days. Pain medication may be necessary, which can be provided intravenously while still in the hospital, then in oral form upon returning home. Antibiotic nose drops should be administered to prevent infection as the nasal passage heals. Use of a zaporizer or humidifier is also beneficial following an endoscopic choanal atresia repair procedure to maintain moisture levels in the airways and help the patient to breathe more comfortably.