Updated: 12/17/2021

Choanal Atresia

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  • Snapshot
    • A newborn is noted to be cyanotic while in the well-baby nursery during feeds. When the feed is withdrawn, the newborn begins to cry and turns pink. A 6 French suction catheter fails to pass through the nose.
  • Introduction
    • Overview
      • posterior nasal airway congenital occlusion
    • Associated conditions
      • can be associated with CHARGE syndrome (Coloboma, Heart defects, Atresia choanase, Retarded growth and development, Genital hypoplasia, and Ear anomalies and deafness)
  • Epidemiology
    • incidence
      • 1 in 5,000-8,000 live births
    • demographics
      • more common in females
    • location
      • unilateral occlusion is more common than bilateral occlusion
    • risk factors
      • a possible risk factor is thionamide (e.g., methimazole) use during pregnancy
  • ETIOLOGY
    • Pathophysiology
      • pathoantomy
        • currently unclear
  • Presentation
    • Symptoms
      • bilateral choanal atresia
        • respiratory distress
          • neonates are nasal breathers for the first 6 weeks of life
        • paradoxical cyanosis
          • cyanotic infant turns pink when crying
      • unilateral choanal atresia
        • foul-smelling secretion from the affected nares
        • may have a unilateral otitis media; however, this is less common
    • Physical exam
      • inability to pass a French catheter into the nasopharynx
      • if associated with CHARGE syndrome, one may find
        • ear anomalies
        • coloboma
        • abnormalities in the genitalia
        • heart defects
  • Imaging
    • Computed tomography (CT) scan
      • indications
        • the test of choice to confirm the diagnosis of choanal atresia
      • views
        • paranasal sinuses and skull base
      • findings
        • includes posterior nasal cavity narrowing and lateral wall thickening of the nasal cavity
  • Studies
    • Diagnostic criteria
      • clinical findings and CT scan of the paranasal sinuses and skull base
  • Differential
    • Bilateral nasolacrimal duct cysts
    • Septal deviation
    • Nasal tumor
  • Treatment
    • Operative
      • intranasal repair
        • indications
          • definitive treatment for choanal atresia
            • must be done as soon as possible for bilateral choanal atresia
          • perform as soon as possible for neonates with bilateral atresia
        • outcome
          • recurrent stenosis may occur
  • Prognosis
    • Prognostic variable
      • negative
        • bilateral choanal atresia can be life-threatening if not quickly treated
  • Complications
    • Aspiration
    • Respiratory arrest
    • Post-surgery renarrowing
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Questions (1)

(M2.ET.15.63) A 34-year-old woman presents to the plastic surgery office 3 months following a rhinoplasty procedure. The patient has been recovering well. However, she has noticed a small whistling noise when she respires through her nose, which you appreciate on physical exam. Which of the following is the most likely cause of this phenomenon?

QID: 106136
1

Post-operative swelling

31%

(30/98)

2

A septal hematoma causing a perforation

40%

(39/98)

3

A deviated septum that is now straight, resulting in altered nasal airflow

12%

(12/98)

4

Excessive columellar show resulting in increased nasal airflow

9%

(9/98)

5

A fracture of the bony septum

7%

(7/98)

M 6 E

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