General Medical Information

Choanal Atresia

Richard L. Mabry

Choanal atresia is a genetic disorder in which the posterior choanae unilaterally or bilaterally fail to develop properly. It occurs in 1 in 5,000 births. Choanal atresia is more common among girls (2:1), and unilateral atresia is more common than bilateral atresia. This disorder can be transmitted as an autosomal recessive trait. Because newborns are obligate nose breathers, bilateral atresia is immediately apparent as respiratory distress. A breathing tube is inserted, and the infant is examined. Characteristics in the history or found at failure to pass a rubber catheter or nasogastric tube into the pharynx can provide enough information for a diagnosis. Symptoms of choanal atresia include failure to thrive due to poor feeding and mucoid discharge from the affected side. The presence of choanal atresia can be confirmed with visualization of retention material in the posterior part of the nose on a lateral radiograph with the patient in the supine position. Anatomic characterization of the deformity with CT can be important for planning surgical procedures.

In the care of an infant, surgical methods for membranous atresia include puncture of the choanal membrane and placement of a stent for 6 weeks. If bony atresia is present, the bony wall can be taken down transnasally with microsurgical techniques followed by placement of a stent. When suboptimal resection for atresia or choanal stenosis occurs, transpalatal repair at 3 or 4 years of age is advised.

Unilateral atresia can go unrecognized until adulthood, at which time the patient seeks medical attention because of possible septal deviation. The septum usually deviates to the affected side; however, more posterior examination shows atresia. Computed tomographic scans of this region provide enough information for a diagnosis. Transpalatal repair is being replaced by endoscopic techniques of repair of atresia in children and adults.