Choanal Atresia Management

Choanal atresia is the congenital closure of the posterior nasal aperture. It is seen approximately once in 5000/8000 births. It may be unilateral or bilateral. Unilateral atresia is twice as common as bilateral atresia. Choanal atresia is twice as common in women than in men. Its etiology needs to be clarified, and there are various theories. Persistent bucconasal membrane, persistent buccopharyngeal membrane, congenital adhesions in mucous membranes, and anomalies in the migration of the cephalic neural crest may be the cause of choanal atresia. Computed tomography and histopathological examinations of choanal atresia cases showed that the atresia was 10% bone and 90% bone and membranous type. Familial predisposition is 20%. The boundaries of choanal atresia are the sphenoid bone superiorly, the vomer medially, the medial pterygoid lamina laterally, and the horizontal part of the maxilla palatum inferiorly. The pterygoid lamina may be medialized in bilateral choanal atresia, and the vomer may be thickened. Choanal atresia can be seen with many craniofacial anomalies and systemic malformations, including skull base defects. The frequency of co-occurrence of another anomaly with choanal atresia is 73.6%. Congenital anomalies in which choanal atresia can occur together are CHARGE 25.6% (C: coloboma, H: heart defect, A: atresia choanae, R: retarded growth and development, G: genital hypoplasia, E: ear anomalies, deafness, extremity abnormalities), branchial anomalies, Treacher-Collins syndrome, Down syndrome, Apert syndrome, Crouzon syndrome, craniosynostosis, meningocele, humeroradial synostosis, mandibular facial synostosis, microcephaly, micrognathia, nasopharyngeal anomalies, and palatal defects can be given as examples.