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Repair of Choanal Atresia

Surgery Overview

Choanal atresia (say "KOH-uh-nul uh-TREE-zhuh") is blockage by bone or tissue of the nasal passages (choana) leading from the back of the nose to the throat. The condition—present at birth in about 1 out of 7,000 babies—makes it impossible to breathe through the nose. Choanal atresia is diagnosed at birth when both passages are blocked. If only one passage is blocked, the diagnosis may be made later, usually after you notice that mucus drains from only one of your baby's nostrils.

Repair involves surgery to reopen the nasal passages. Your baby may have a computed tomography (CT) scan, a form of X-ray, before the repair to help the doctor confirm the diagnosis and plan the surgery.

Your baby will receive general anesthesia for the operation. The surgeon can choose one of two approaches: inserting instruments through the nostrils (transnasal) or making an incision in the roof of the mouth (transpalatal). The doctor chooses the approach based on several things, including the anatomy of the nasal passages. The surgeon may prefer to operate through the nose if thin tissue blocks the nasal passages. He or she may prefer to do the surgery through the roof of the mouth if thick bone blocks the nasal passages.

In both approaches, the doctor stitches tubes called nasal stents into the passages to keep them open. After 6 or more weeks, the doctor removes the stents.

What to Expect After Surgery

After surgery, your baby should be able to breathe normally and will be able to breast-feed or bottle-feed. Newborns stay in the hospital for a few days. Older children who have surgery on one side may go home after a day or two. Health professionals will teach you how to suction your baby's nasal passages at home to keep the stents open until they can be removed. They also will have you watch for complications (such as infection or bleeding) and will tell you when to call if a problem develops.

After the stents are removed, the doctor may use a thin, lighted instrument (endoscope) to look into the nose to make sure the airways are open.

Why It Is Done

The surgery opens nasal passages to allow the baby to breathe. A newborn can only breathe through the nose (except when crying) in the first weeks of life.

How Well It Works

Surgery cures the problem. Most children need only one operation. But in some cases, the procedure may be repeated if the nasal passages close again.

Risks

The main risk of surgery to repair choanal atresia is needing another surgery if the airway does not stay open.

In general, children have a small risk of infection or bleeding. Any surgery involving general anesthesia carries a small amount of risk. Call the doctor if your child has bleeding, a fever of 38.1°C (100.6°F), pus coming from the nose, or you are unable to keep the stents clear so your child can breathe.

Injury to the nasal passages and skull may occur during surgery. But this is rare.

What to Think About

Surgery may be delayed until the child is 2 or 3 years old if only one nasal passage is blocked.

The transnasal method requires less operating time than the transpalatal approach. But the risk of the nasal passages closing again may be higher with the transnasal approach.

Other Places To Get Help

Organizations

American Rhinologic Society
Web Address: http://american-rhinologic.org


American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)
Web Address: www.entnet.org


Canadian Society of Otolaryngology Head and Neck Surgery
Web Address: www.entcanada.org


References

Other Works Consulted

  • Laane CJ (2004). Congenital anomalies of the nose. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology, 1st ed., pp. 245–255. New York: Lange Medical Books/McGraw-Hill.

Credits

By Healthwise Staff
Adam Husney, MD - Family Medicine
Anne C. Poinier, MD - Internal Medicine
Donald R. Mintz, MD - Otolaryngology
Last Revised December 29, 2011
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