From the Guidelines
For a 1-month-old with choanal atresia, removing adenoids will not make choanal atresia surgery easier because adenoids are typically underdeveloped in neonates. The adenoid tissue is minimal at this age and not a significant factor in surgical access or outcomes for choanal atresia repair 1.
Key Considerations
- Adenoids develop as lymphoid tissue in the nasopharynx, while the pterygobasilar fascia (also called pharyngobasilar fascia) is a connective tissue structure that forms part of the pharyngeal wall.
- These are distinct anatomical structures with different embryological origins.
- The adenoid tissue develops from the nasopharyngeal tonsil in the roof and posterior wall of the nasopharynx.
Management of Choanal Atresia
In managing choanal atresia in a neonate, the focus should be on establishing an airway, which may require immediate surgical correction of the atresia rather than adenoid considerations 1.
Surgical Approach
The micro-endoscopic, endonasal approach is preferable for correcting choanal atresia, offering numerous technical options and variations 1.
Postoperative Management
Repeated endoscopic controls are combined with 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.
Additional Points
- No stents are applied into the nasal airways 1.
- 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. Note that the evidence from 1 is not directly relevant to the management of choanal atresia in a neonate, as it discusses the treatment of otitis media with effusion.
From the Research
Choanal Atresia and Surgical Approaches
- Choanal atresia is a congenital obstruction of the posterior nasal apertures, and multiple surgical techniques have been proposed to repair the atresia 2.
- The choice of surgical approach depends on the patient's age, with the transnasal approach preferred in infants and younger children, and the transpalatal or trans-septal approach preferred in older children and adults 3.
Adenoids and Choanal Atresia Surgery
- There is no direct evidence to suggest that removing adenoids will make choanal atresia surgery easier.
- The provided studies discuss various surgical approaches for choanal atresia, including transnasal, transpalatal, and trans-septal, but do not mention the role of adenoids in the surgery 2, 3, 4, 5, 6.
Embryologic Analysis and Treatment Evolution
- The embryologic analysis of choanal atresia suggests that it is a congenital obstruction of the posterior nasal apertures, and the treatment has evolved over time to include various surgical approaches 2.
- The senior author of one study has evolved to favoring the endoscopic approach, which has a minimal long-term complication rate and low stenosis rate 2.