Management and outcome of choanal atresia correction

Objectives: Outcome analyses of factors that may either maximize success or predict a better outcome following choanal atresia correction. Methods: A retrospective review of children undergoing choanal atresia correction at Great Ormond Street Hospital for Children, London between January 1990 and April 1998. Children with unilateral or bilateral choanal atresia were studied. In all cases, correction was by a transnasal approach under endoscopic control. A 120°Hopkins rod telescope was used to visualize the atretic plate from the nasopharynx. Straight urethral sounds were used to perforate the plate followed by use of an air drill to remove the bony component. Portex endotracheal tubes were subsequently inserted as nasal stents. Results: Sixty-five children (19 M, 46 F: age range 1 day to 17 years) presented with choanal atresia and the outcomes for 46 were included in the study. Twenty-six patients (40%) had other major anomalies. In children with unilateral atresia neither duration of stenting nor presence of facial anomalies had an impact on outcome. Of those children with bilateral choanal atresia and associated facial anomalies (n = 9), 56% were asymptomatic following correction. In children with isolated bilateral choanal atresia (n = 19), 74% were asymptomatic following correction; 29% (n = 7) of infants who weighed ≤ 2.3 kg were asymptomatic as compared to 81% of infants that weighed > 2.3 kg (n = 21). Patients with a stent size of > 3.5 mm (n = 6) had an 83% chance of a good outcome. Those patients stented with a tube ≤ 3.5 mm (n = 22) had only a 64% success rate. None of the patients who were stented for at least 12 weeks remained symptomatic. Conclusions: Neonates with bilateral choanal atresia who were stented for at least 12 weeks with the largest Portex tube that comfortably passed through the anterior nares had the best outcome. If they had either associated anomalies or low weight at surgery, they were less likely to become asymptomatic. For patients with unilateral choanal atresia, neither the presence of facial anomalies nor stent duration had an impact on outcome. (C) 2000 Elsevier Science Ireland Ltd.