From the Guidelines
The recommended surgical procedure for endoscopic repair of choanal atresia is a micro-endoscopic, endonasal approach with the application of topical Mitomycin C intraoperatively and postoperative transnasal dilations, without the use of stents. This approach is based on the most recent and highest quality study available, which suggests that the use of stents can lead to a higher incidence of restenosis and that topical Mitomycin C can reduce excessive granulation and scar formation 1. The procedure involves removing the obstructing tissue, which may be membranous, bony, or mixed in composition, and creating an adequate opening using specialized instruments such as microdebriders, drills, or lasers.
Key Steps in the Procedure
- The surgery begins with the insertion of an endoscope through the nostril to visualize the atretic plate
- The surgeon identifies key landmarks including the vomer bone, lateral nasal wall, and floor of the nose
- The atretic plate is removed with all compounds, based on preoperative analysis of the individual deformity and knowledge of potential concomitant malformations
- Topical Mitomycin C is applied intraoperatively for 10 minutes in a dilution of 0.4 mg/ml to reduce excessive granulation and scar formation 1
- Postoperative management includes repeated endoscopic controls and transnasal dilations with a soft rubber bougie in increasing intervals, performed by the surgeon initially and by parents or patients in a further outpatient follow up for up to one year
Advantages of the Recommended Approach
- Reduced operative time
- Less blood loss
- Faster recovery
- Avoidance of potential growth disturbances to the maxillofacial complex in developing children
- Lower incidence of restenosis compared to the use of stents 1
Postoperative Care
- Saline irrigations
- Topical antibiotics
- Regular follow-up to monitor for restenosis
- Transnasal dilations with a soft rubber bougie in increasing intervals, performed by the surgeon initially and by parents or patients in a further outpatient follow up for up to one year 1
From the Research
Surgical Procedure for Endoscopic Repair of Choanal Atresia
The surgical procedure for endoscopic repair of choanal atresia involves several steps, including:
- Perforation of the bony choanal plates 2
- Resection of the posterior portion of the vomer bone 3
- Drilling of the lateral choanae 2
- Removal of the atretic bony plate 4
- Perforation of the mucosa 4
- Use of a balloon dilator to dilate the neochoanae and prevent restenosis 4
- Use of stents to maintain patency of the neochoanae 4, 5
- Creation of mucosal flaps to preserve the mucosa and promote healing 6
Techniques Used
Different techniques have been used for endoscopic repair of choanal atresia, including:
- Transnasal endoscopic approach 4, 2, 3, 5
- Endoscopic transseptal approach 6
- Use of power instruments, such as microdebriders 2, 5
- Use of image-guided surgery 2
- Application of topical mitomycin-C to minimize post-operative scarring 2
Postoperative Care
Postoperative care for endoscopic repair of choanal atresia includes: