Surgery is currently the only definitive treatment for congenital choanal atresia (CCA). There are various surgical approaches including transnasal, transeptal or transpalatal. The authors propose that the preferred option is transnasal endoscopic choanal atresia surgery (TECAS) and set out to evaluate their surgical outcomes having used TECAS to treat their patients. They present the results of a retrospective study, assessing the surgical outcome of 48 patients, aged one day to 45 years with unilateral or bilateral, bony or mixed, CCA who underwent TECAS by their department in Malatya, Turkey from August 2000 to April 2014. All patients underwent endoscopic examination and CT scanning preoperatively. Perforation of the bony atretic plate was achieved using an otologic microdrill with a diamond burr, with the aperture widened to the lower end of the middle turbinate superiorly, and vomer and lateral bone resection towards the medial pterygoid inferomedially using the drill or back-biter. Silicon stents were inserted in 41 patients and left in for three days to two weeks. Postoperative hospital stay was two to three days. Within a six-month follow-up period, 34 (70.8%) patients had less than 50% narrowing of the neoaperture (considered successful surgery by the authors) and 14 (29.2%) had restenosis of more than 50% requiring revision surgery. Patients operated at ages less than six months had a higher failure rate (33.6% vs 87.8%). Seven of the patients without stents did not have stenosis formation within six months. The mean stenting time for those with stenosis and those without stenosis formation was 9.64 (SD 3.43) and 8.00 (SD 2.06) days respectively. The authors highlight the many advantages of TECAS and that stenosis formation is still a significant problem. Whether to stent or not and its duration remains a topic of debate.
Transnasal endoscopic choanal atresia surgery
Reviewed by Richard Gan
Treatment of congenital choanal atresia via transnasal endoscopic method.
CONTRIBUTOR
Richard (Wei Chern) Gan
Royal Brisbane and Women's Hospital, Australia.
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