Endoscopic choanal atresia repair

Choanal atresia (CA) is a congenital anomaly, with an incidence of 1:5,000-8,000 births. It occurs more frequently in girls than boys and is more often unilateral than bilateral. The presenting symptoms vary from mild airway obstruction in unilateral disease to acute respiratory distress in bilateral atresia. The diagnosis is based on endoscopy and computed tomography scan. In this report, we review the variety of surgical procedures that have been proposed for CA repair, including transnasal puncture, transnasal drillout, transseptal, transpalatal, and endoscopic transnasal technique. Special attention is given to endoscopic technique with powered instrumentation, which is the technique routinely used in our institution. During the past 2 years we performed 10 endoscopic CA repairs, including 1 revision. One case was navigation-assisted. We have used endoscopic equipment in all cases, including revisions, with an initial success rate of 80%. The described approach is chracterized by low morbidity and an immediate alleviation of the child's nasal obstruction, with a prompt return to normal diet and breathing. We believe that endoscopic technique is the best approach available today, and it should be used in primary repair as well as in revisions.