Transnasal endoscopic repair of choanal atresia in a tertiary care centre: a review of outcomes.

Introduction/aim: Choanal atresia (CA) is an obliteration, in newborns, of the airway at the level of posterior nasal aperture resulting in absence of connection between the nasal cavity and the aerodigestive tract. It is rare, with incidence of 1 in 7000 live births. This review is aimed at assessing the factors influencing the outcome of transnasal endoscopic repair of CA in a tertiary referral children's hospital.

Material/method: A retrospective study was carried out between 2002 and 2009. 31 children; 14 boys and 17 girls, age range 1 day to 15 years, mean 23.4 months were included. Unilateral presentation was 19 (11 right, 8 left) and bilateral was 12. All patients had transnasal endoscopic repair under direct vision. Nasal stents were placed for varying duration (range 4-12 weeks) or nasopharyngeal airways (removed within 24h) were inserted at time of surgery. Patients were monitored for re-stenosis and revisions carried out as necessary, with a mean follow-up of 11.9 months.

Results: 54.7% (n=17) of patients had re-stenosis requiring revision surgery. Of these, 41.1% (n=7) had success after the 1st revision, 20% had success after the 2nd revision while 12.3% had success after the 3rd revision. One patient required more than four revisions. 80% of re-stenosis requiring revisions occurred in children who had surgery under 10 months of age and of these, approx. 42% were 1-week-old or younger. 57% of those who had stents for 4-6 weeks (n=15) had re-stenosis requiring revision while only 33.3% of those who either had no stents or had NP airways removed within 24h (n=16) had re-stenosis (P=0.019). The re-stenosis rate was comparable for those who had mitomycin (53%) versus those who did not (60%).

Conclusion: Transnasal endoscopic repair of CA is effective and safe and provides the benefit of surgery under direct vision. Age 1 week or less was a predictive factor for re-stenosis. Intranasal stents was also associated with increased incidence of re-stenosis and the use of mitomycin C does not seem to have any significant effect on re-stenosis.