Last update: 02.12.2009
Paraya Assanasen MD*,Choakchai Metheetrairut MD*
Choanal atresia is caused by failure of resorption of the bucco-pharyngeal membrane during embryonic
development. The atresia can be membranous or bony in nature, but is usually mixed in most cases. When
the atresia is bilateral, newborns can have severe airway distress and cyanosis is alleviated by crying.
Bilateral choanal atresia is managed with an oropharyngeal airway. Flexible nasal endoscopy and computed
tomography can confirm the diagnosis. Surgery is the definitive treatment with two main approaches, namely
transnasal or transpalatal. The transnasal route is currently the preferred procedure and can be performed in
a minimally invasive fashion with endoscopic instrumentation. It is a safe and rapid procedure even in very
young children, with no complications and a high rate of success. The use of a navigation system for surgical
planning and intraoperative guidance and powered instrumentation can improve treatment outcome. The
transpalatal approach is more invasive and reserved for failed endoscopic cases.