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 G reat Ormond Street Hospital for Children, London between January 1990 and A pril 1998. Children with unilateral or bilateral choanal atresia were studi ed. In all cases, correction was by a transnasal approach under endoscopic control. A 120 degrees Hopkins rod telescope was used to Visualize the atre tic plate from the nasopharynx. Straight urethral sounds were used to perfo rate the plate followed by use of an air drill to remove the bony component . Porter endotracheal tubes were subsequently inserted as nasal stents. Res ults: Sixty-five children (19 M, 46 F: age range 1 day to 17 years) present ed with choanal atresia and the outcomes for 46 were included in the study. Twenty-six patients (40%) had other major anomalies. In children with unil ateral atresia neither duration of stenting nor presence of facial anomalie s had an impact on outcome. Of those children with bilateral choanal atresi a and associated facial anomalies (n = 9), 56% were asymptomatic following correction. In children with isolated bilateral choanal atresia (n = 19), 7 4% were asymptomatic following correction; 29% (n = 7) of infants who weigh ed less than or equal to 2.3 kg were asymptomatic as compared to 81% of inf ants 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 less than or equal to 3.5 mm (n = 22) had only a 64% success rate. No ne of the patients who were stented for at least 12 weeks remained symptoma tic. Conclusions: Neonates with bilateral choanal atresia who were stented for at least 12 weeks with the largest Porter tube that comfortably passed through the anterior nares had the best outcome. If they had either associa ted anomalies or low weight at surgery, they were less likely to become asy mptomatic. For patients with unilateral choanal atresia, neither the presen ce of facial anomalies nor stent duration had an impact on outcome. (C) 200 0 Elsevier Science Ireland Ltd. All rights reserved.