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DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.

CONGENITAL CHOANAL
ATRESIA
*C.S. Ray, **Rabindra K. Khatua
ABSTRACT
choanal

atresia

(CCA)

is

the

Congenital choanal atresia (CCA) is an uncommon

developmental failure of the nasal cavity to communicate

malformation with an estimated incidence of1:5000to

with the nasopharynx. Bilateral choanal atresia is

1:10000 live births. Atresia may be bony, mixed bony-

potentially life threatening in newborns. Most of these

membranous or purely membranous . Most cases of

cases present early in life with cyclical phases of

choanal atresia are isolated malformation, but association

respiratory distress and apnoea, which gets relieved by

with other congenital deformities has been reported in

crying. In fewer cases it goes undiagnosed to present in

literature.

adult life with rhinorrhoea and nasal obstruction. We


report a rare case of bilateral choanal atresia presenting
for the first time at 19 years of age with presenting with
bilateral nasal obsruction, rhinorrhoea and anosmia. His
neonatal history was unremarkable. Endoscopy and CT
scan confirmed atresia. The patient was successfully
treated by transpalatal technique.

Key words: Choanal atresia, adult.


Address of Correspondence:
Dr. C. S. Roy
Asst. Professor
Dept. of ENT. & HNS S.C.B. Medical College,
Cuttack-753007
Ph.: 9437309016

Commonest

among

which

is

CHARGE

Syndrome( coloboma, heart defects, atresia choanal,


2

retarded growth, ear deformities) .Unilateral atresia may


go undiagnosed and unrecognized until later in life since
respiratory distress is usually not encountered at birth.
Bilateral choanal atresia is a life threatening condition in
newborns. It is treated initially in newborn stage
conservatively, then surgically later. However in rare
cases like ours it may be diagnosed late in adult life with
other symptoms.

CASE REPORT
A 19-year-old male patient presented with long
standing bilateral nasal obstruction, mouth breathing,
mucoid nasal discharge, and anosmia. There was no
history suggestive of respiratory distress and his neonatal
history was unremarkable. There was no symptom
suggestive of any other anomalies. Local examination
revealed the patient had elongated face, high arched
palate and mucopurulent discharge in both nostrils with
no airflow at the anterior nares. An attempt to pass a
suction catheter into nasopharynx was unsuccessful.
Diagnostic endoscopies revealed complete blockage of

*Asst. Professor, **Senior resident, Dept. ENT & Head & Neck Surgery, SCB Medical College Cuttack.

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Vol.-9, Issue-I, Jan-June - 2015

Congenital

INTRODUCTION

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

both nostrils posteriorly. The diagnosis of bilateral


choanal atresia was confirmed by axial CTscan that
showed bilateral bony atretic plate with bony septal
deviation posteriorly to left side (figure 1). A trans
palatal approach was used to provide a nasal airway.
Bilateral atretic plates were removed and the deviated
bony spur was removed. The neo-choana was stented
with no.5/6portex endotracheal tube for 8 weeks (figure
2). Check endoscopies and local debridement was done
every month for few months. On left side dilatation was
required twice, which was done endoscopically. CT scan
after 10 months of surgery revealed a patent choana on Fig 2: C.T. scan of same patient co................
both sides (figure3).
DISCUSSION:
Congenital choanal atresia was first reported
3
in1830 . Especially bilateral cases are usually part
4

of various craniofacial syndromes .


Bilateral

choanal

atresia

causes

acute

life

threatening respiratory distress in newborns within hours


of parturition as neonates are obligate nasal breathers.
The symptoms gets relieved by crying and worsened by
feeding. The diagnosis is established easily in neonate

Fig 3: C.T. scan showing bilateral choanal atresia.

age by the inability to pass a suction catheter into


nasopharynx. However, CT scan of nose and skull
base is confirmatory both for diagnosis and
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Vol.-9, Issue-I, Jan-June - 2015

assessing the extent and thickness of atretic plate .

Our case is unusual since he presented for


the first time at 19 years of age with bilateral
disease and with no significant history of postnatal
respiratory distress or intubations or surgery in
early childhood as reported by patients parents.
Baker et al have hypothesized that very rarely a
newborn with bilateral choanal atresia may compensate
Fig 1: Patient with stents in both nostrils.

42

by rapidly learning mouth breathing and therefore the

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

atersia without prolonged stenting.Arch


otolaryngol Head Neck Surg.2002;128:936-40.

diagnosis may be delayed for months or years in


6
few instances.
For providing a nasal airway two techniques are

3.

Otto AW.Lehrbuch der pathologie,Anatomy des


Menschen under thiere.berlin:RuckerA.,1830.

4.

Ferguson JL,NeelHB.Choanal atresia; treatment

used: Endo- nasal and trans -palatal approach. Endo7,8

nasal method can be by use of rigid endoscopes

or

microscope . These methods are used for primary

treands in 47 patients over 33 years.Ann Otol

repair of membranous or thin bony atresias. But,

Rhinol Laryngol.1989;98:110-113.

restenosis remains an important problem. But, these


have been attributed to local infection, local granuloma,

5.

Crockett DM,Healy GB,Mc Gillt J,et


al.Computed tomograghy in evaluation of
choanal atresia in infants and children.
Laryngoscope. 1997;97:174-183.

6.

Baker DC Jr, Walter JG, Novick W.Posterior


choanal atresia. Ann Oto RhinolLarygol.
1960; 69:805-809.

7.

Laera

foreign boby reaction to stent and synechia. Although,


transpalatal repair is a bigger operation, has some
bigger advantages like wider exposure, creation of
larger neo-choana initially and decreased incidences of
restenosis. In our case,since the patient was adult with
thick bony atretic plate and posterior bony septal
deviation, we preferred the trans-palatal method.

DISCLOSURES

choanal

2.

VanDen
Abbeele,
Francois
M,Nancy
P.Transnasal endoscopic treatment of choanal

of

telescopes.Arch

atresia:experience with transnasal endoscopic

technique.Ind J Otolaryngol Head Neck

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Brown Orval E., Pownell Patrick, Manning
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using

repair

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(c) Funding - None

1.

atresia

RT.Trannasal

Otolargol Head Neck Surg.1995;121:517-520.

(a) Competing interests/Interests of Conflict- None

(b) Sponsorships - None

RH,Yonnis

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Maher
A.,Belal
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Vol.-9, Issue-I, Jan-June - 2015