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The work illustrates a step-by-step surgical approach to demonstrate technical feasibility of a single-stage endoscopic repair for bilateral choanal atresia with adjuvant bioabsorbable steroid-eluting stent placement to safely mitigate unique perioperative challenges in the pediatric population. Laryngoscope, 134:4414-4417, 2024.

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La atresia de coanas se caracteriza por la obliteración de la abertura nasal posterior. Es la anomalía congénita más frecuente de las fosas nasales. Tiene una incidencia de 1 cada 5000 a 7000 neonatos, con predominio en el sexo femenino. Puede presentarse en forma aislada o asociada a otros síndromes como el CHARGE (coloboma [C], malformaciones cardíacas [H], atresia de coanas [A], retraso psicomotor y/o en el crecimiento [R], hipoplasia de genitales [G], malformaciones auriculares y/o sordera [E, por su sigla en inglés]). Las manifestaciones clínicas son la obstrucción nasal, cianosis y dificultad respiratoria desde el nacimiento cuando es bilateral. Las atresias unilaterales se caracterizan por insuficiencia ventilatoria nasal y rinorrea unilateral, y pueden pasar inadvertidas. El diagnóstico se realiza mediante endoscopia y estudios por imágenes. El tratamiento es quirúrgico; existen diferentes técnicas y vías de abordaje. Se presenta el caso de un paciente masculino de 7 años con atresia unilateral de coana derecha con resolución microendoscópica, colocación de tutor externo, con buena resolución.

Choanal atresia is characterized by obliteration of the posterior nasal opening. It is the most common congenital anomaly of the nasal passages. It has an incidence of 1 in 5000 to 7000 newborns; predominantly female. It can occur in isolation or in association with other syndromes such as CHARGE (coloboma [C], cardiac malformations [H], choanal atresia [A], psychomotor and/or growth retardation [R], genital hypoplasia [G], atrial malformations and/or deafness [E]. Clinicallypresents nasal obstruction, cyanosis and respiratory distress from birth when bilateral, unilateral atresias are characterized by nasal ventilatory insufficiency and unilateral rhinorrhea, which may go unnoticed. Diagnosis is made by endoscopy and imaging tests. Treatment is surgical, with different techniques and approaches.A 7-year-old male patient is presented with unilateral atresia of the right choana with microendoscopic resolution, placement of an external tutor, with good resolution.

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Choanal atresia is characterized by obliteration of the posterior nasal opening. It is the most common congenital anomaly of the nasal passages. It has an incidence of 1 in 5000 to 7000 newborns; predominantly female. It can occur in isolation or in association with other syndromes such as CHARGE (coloboma [C], cardiac malformations [H], choanal atresia [A], psychomotor and/or growth retardation [R], genital hypoplasia [G], atrial malformations and/or deafness [E]. Clinically presents nasal obstruction, cyanosis and respiratory distress from birth when bilateral, unilateral atresias are characterized by nasal ventilatory insufficiency and unilateral rhinorrhea, which may go unnoticed. Diagnosis is made by endoscopy and imaging tests. Treatment is surgical, with different techniques and approaches. A 7-year-old male patient is presented with unilateral atresia of the right choana with microendoscopic resolution, placement of an external tutor, with good resolution.

La atresia de coanas se caracteriza por la obliteración de la abertura nasal posterior. Es la anomalía congénita más frecuente de las fosas nasales. Tiene una incidencia de 1 cada 5000 a 7000 neonatos, con predominio en el sexo femenino. Puede presentarse en forma aislada o asociada a otros síndromes como el CHARGE (coloboma [C], malformaciones cardíacas [H], atresia de coanas [A], retraso psicomotor y/o en el crecimiento [R], hipoplasia de genitales [G], malformaciones auriculares y/o sordera [E, por su sigla en inglés]). Las manifestaciones clínicas son la obstrucción nasal, cianosis y dificultad respiratoria desde el nacimiento cuando es bilateral. Las atresias unilaterales se caracterizan por insuficiencia ventilatoria nasal y rinorrea unilateral, y pueden pasar inadvertidas. El diagnóstico se realiza mediante endoscopia y estudios por imágenes. El tratamiento es quirúrgico; existen diferentes técnicas y vías de abordaje. Se presenta el caso de un paciente masculino de 7años con atresia unilateral de coana derecha con resolución microendoscópica, colocación de tutor externo, con buena resolución.

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La atresia de coana es una rara malformación congénita improbable de encontrar de forma bilateral en un adolescente o adulto. Hasta la fecha, no se ha descrito ningún caso de atresia bilateral en un adulto con una malformación asociada de cabeza y cuello que haya requerido tratamiento conjunto. El tratamiento de elección de la atresia de coana bilateral continúa siendo la cirugía endoscópica, con controversia en el uso intraoperatorio de mitomicina o la colocación de stents para evitar estenosis. Lo que no está claro es el orden de tratamiento y la simultaneidad del procedimiento si se asocian otras posibles patologías que tengan una indicación quirúrgica. Presentamos un caso clínico que cumple con todos estos requisitos.

Choanal atresia is a rare congenital malformation that is unlikely to be found bilaterally and is seldom diagnosed in adulthood. To date, no clinical case of bilateral atresia has been described with a head and neck malformation that requires surgical treatment in an adult. The preferred treatment is still endoscopic sinonasal surgery with discrepancies of the use or not of intraoperative topical mitomycin or the placement of stents to avoid restenosis. What is not clear is the order of treatment and simultaneity of the procedure with other possible associated pathologies that have a surgical indication. We present a clinical case that meets all these requirements.

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La atresia congénita de coanas se caracteriza por la presencia de placas que obliteran la comunicación entre la cavidad nasal y la nasofaringe desde el nacimiento. Se considera como incompatible con la vida cuando la condición es bilateral. El siguiente es el caso de una paciente femenina, de 17 años, sin síndromes asociados, con obstrucción y descarga nasal anterior bilateral, asociado a respiración oral desde el periodo neonatal. El diagnóstico de atresia bilateral de coanas fue confirmado por medio de endoscopía nasal y tomografía computarizada (TC). La imagen confirmó la presencia de placas atrésicas de composición mixta. La paciente recibió tratamiento quirúrgicamente por vía transnasal con resección de las placas y modelado de neocoana.

Congenital choanal atresia is characterized by the presence of plates obliterating the communication between the nasal cavity and the nasopharynx from birth. If bilateral, this condition is incompatible with life. This following is the case of a 17-year-old female patient, without associated syndromes, with bilateral nasal obstruction and anterior discharge, associated to oral breathing, starting in her neonatal period. The diagnosis of bilateral choanal atresia was confirmed by nasal endoscopy and computed tomography (CT) scan, due to the presence of atretic plates of mixed composition. The patient was surgically treated with plate resection and modeling of a neochoana by means of a transnasal surgical approach.

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OBJECTIVE: To analyze prognostic factors in the management of patients with choanal atresia. STUDY DESIGN: This is a review of 114 patients operated on for choanal atresia in a tertiary care center between November 1986 and November 2016, including clinical characteristics, surgical management, and postoperative course with final nasal patency. The data were collected in a database that was updated over time. RESULTS: Among the 114 patients, 78 were female, 77 presented with unilateral choanal atresia, and 37 presented with bilateral unilateral choanal atresia, corresponding to 151 nasal fossae. Forty-seven patients had associated abnormalities (41.2%), including CHARGE, diagnosed in 20 children (17.5%). At the end of follow-up, 91 patients (79.8%) had normal choanal patency. The identified risk factors of surgical failure were age <6 months (P = .004), weight <5 kg (P = .007), and bilateral choanal atresia (P < .001). The type of atresia, presence of associated abnormalities, surgical approach, stenting, and use of mitomycin were not significantly linked with the surgical results. CONCLUSIONS: This series highlights the importance of the timing of surgery, which is guided by the clinical ability of the infant to tolerate the procedure. Endoscopic approaches are widely performed, but a transpalatal approach, necessary in some cases of bilateral choanal atresia, does not alter the results. Unilateral choanal atresia surgery should be delayed after age 6 months and/or weight >5 kg when possible.

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Abstract Introduction: Choanal atresia is a rare congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae. In 67% of cases choanal atresia is unilateral, affecting mainly (71%) the right nasal cavity. In contrast to the unilateral form, bilateral choanal atresia is a life-threatening condition often associated with respiratory distress with feeding and intermittent cyanosis exacerbated by crying. Surgical treatment remains the only therapeutic option. Objective: To report our experience in the use of a transnasal endoscopic approach with stentless single side-hinged flap technique for the surgical management of choanal atresia. Methods: A 5 year retrospective analysis of surgical outcomes of 18 patients treated for choanal atresia with a transnasal technique employing a single side-hinged flap without stent placement. All subjects were assessed preoperatively with a nasal endoscopy and a Maxillofacial computed tomography scan. Results: Ten males and eight females with a mean age at the time of surgery of 20.05 ± 11.32 years, underwent surgery for choanal atresia. Fifteen subjects (83.33%) had a bony while 3 (26.77%) a mixed bony-membranous atretic plate. Two and sixteen cases suffered from bilateral and unilateral choanal atresia respectively. No intra- and/or early postoperative complications were observed. Between 2 and 3 months after surgery two cases (11.11%) of partial restenosis were found. Only one of these presented a relapse of the nasal obstruction and was subsequently successfully repaired with a second endoscopic procedure. Conclusion: The surgical technique described follows the basic requirements of corrective surgery and allows good visualization, evaluation and treatment of the atretic plate and the posterior third of the septum, in order to create the new choanal opening. We believe that the use of a stent is not necessary, as recommended in case of other surgical techniques involving the use of more mucosal flaps.

Resumo Introdução: A atresia de coanas é uma malformação congênita rara da cavidade nasal caracterizada pela obliteração completa da coana posterior. Em 67% dos casos a atresia coanal é unilateral, acomete principalmente (71%) a cavidade nasal direita. Diferentemente da forma unilateral, a atresia coanal bilateral é uma condição com risco de vida, frequentemente associada a insuficiência respiratória à alimentação e cianose intermitente exacerbada pelo choro. O tratamento cirúrgico ainda é a única opção terapêutica. Objetivo: Relatar a nossa experiência no uso de uma abordagem endoscópica transnasal com a técnica de retalho articulado de um lado só sem colocação de stent para o tratamento cirúrgico da atresia coanal. Método: Análise retrospectiva de 5 anos dos desfechos cirúrgicos de 18 pacientes tratados para atresia coanal com uma técnica transnasal com um único retalho de articulação lateral, sem colocação de stent. Todos os indivíduos foram avaliados no pré-operatório com endoscopia nasal e um exame de tomografia computadorizada maxilofacial. Resultados: Dez homens e oito mulheres com idade média de 20,05 ± 11,32 anos à cirurgia foram submetidos a cirurgia para atresia de coanas. Quinze (83,33%) apresentavam placa atrésica óssea e três (26,77%) placa atrésica ósseo-membranosa mista. Dois e 16 casos tinham atresia coanal bilateral e unilateral, respectivamente. Não foram observadas complicações intra e/ou pós-operatórias precoces. Entre 2 e 3 meses após a cirurgia dois casos (11,11%) de restenose parcial foram identificados. Apenas um deles apresentou uma recidiva da obstrução nasal e, portanto, foi reparado com sucesso com um segundo procedimento endoscópico. Conclusão: A técnica cirúrgica descrita segue os requisitos básicos de cirurgia corretiva e possibilita boa visualização, avaliação e tratamento da placa atrésica e do terço posterior do septo, a fim de criar a nova abertura coanal. Pensamos que o uso de um stent não é necessário, tal como recomendado no caso de outras técnicas cirúrgicas que envolvem o uso de mais retalhos de mucosas.

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INTRODUCTION: Choanal atresia is a rare congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae. In 67% of cases choanal atresia is unilateral, affecting mainly (71%) the right nasal cavity. In contrast to the unilateral form, bilateral choanal atresia is a life-threatening condition often associated with respiratory distress with feeding and intermittent cyanosis exacerbated by crying. Surgical treatment remains the only therapeutic option. OBJECTIVE: To report our experience in the use of a transnasal endoscopic approach with stentless single side-hinged flap technique for the surgical management of choanal atresia. METHODS: A 5 year retrospective analysis of surgical outcomes of 18 patients treated for choanal atresia with a transnasal technique employing a single side-hinged flap without stent placement. All subjects were assessed preoperatively with a nasal endoscopy and a Maxillofacial computed tomography scan. RESULTS: Ten males and eight females with a mean age at the time of surgery of 20.05±11.32 years, underwent surgery for choanal atresia. Fifteen subjects (83.33%) had a bony while 3 (26.77%) a mixed bony-membranous atretic plate. Two and sixteen cases suffered from bilateral and unilateral choanal atresia respectively. No intra- and/or early postoperative complications were observed. Between 2 and 3 months after surgery two cases (11.11%) of partial restenosis were found. Only one of these presented a relapse of the nasal obstruction and was subsequently successfully repaired with a second endoscopic procedure. CONCLUSION: The surgical technique described follows the basic requirements of corrective surgery and allows good visualization, evaluation and treatment of the atretic plate and the posterior third of the septum, in order to create the new choanal opening. We believe that the use of a stent is not necessary, as recommended in case of other surgical techniques involving the use of more mucosal flaps.

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Introducción: la atresia de coanas es una anomalía congénita nasal con una incidencia de 1/70.000 nacidos vivos en Argentina. Se presenta con dificultad respiratoria desde el nacimiento en el caso de las bilaterales. Presentaremos 2 casos de pacientes masculinos con atresia de coanas bilateral diagnosticados tardíamente. Para su tratamiento se utilizó técnica endoscópica transeptal con colgajos doblados sin tutores y azitromicina como antiinflamatorio de mucosa respiratoria en el postquirúrgico. Material y método: Se valoraron en forma descriptiva y retrospectiva 2 pacientes adolescentes diagnosticados e intervenidos quirúrgicamente en el Servicio de Otorrinolaringología del Hospital Posadas, mediante técnica endoscópica transeptal con colgajos doblados sin tutores. Se analizaron variables como tipo de placa atrésica, edad de diagnóstico, malformaciones asociadas y resultados quirúrgicos. Como tratamiento médico postquirúrgico, se utilizó azitromicina a dosis antiinflamatorias. Resultados: La técnica endoscópica transnasal con colgajos doblados sin tutor que hemos realizado en estos dos pacientes reduce el riesgo de reestenosis, no requiere reintervenciones posteriores para retirar el stent y genera una mejor tolerancia del paciente en el postoperatorio. El uso de azitromicina postoperatoria disminuyó el proceso inflamatorio favoreciendo la cicatrización, lográndose una correcta permeabilización de las coanas y una respiración nasal normal bilateral. Conclusiones: El diagnóstico temprano en este tipo de pacientes es fundamental, debido a la característica de respiradores nasales estrictos que presentan los neonatos. No se han encontrado reportes de pacientes diagnosticados en la adolescencia, por lo cual el diagnóstico y el tratamiento, en este caso, plantearon también un desafío.

Introduction: choanal atresia is a nasal congenital anomaly with an incidence of 1 / 70,000 live births in Argentina. It presents with respiratory difficulty from birth in bilateral cases. We will present 2 cases of male patients with bilateral choanal atresia of late diagnose. We used a trans-septal endoscopic technique with folded flap without tutors and azithromycin as an anti-inflammatory of the respiratory mucosa in the postoperative time. Material and method: A descriptive and retrospective study was carried out on 2 adolescent patients diagnosed and surgically treated in the Otorhinolaryngology Service of the Posadas Hospital, using transeptal endoscopy with a folded flap technique without tutors. Variables such as atresia plaque type, age of diagnosis, associated malformations, complications and surgical results were analyzed. Azithromycin was used at anti-inflammatory doses as a post-surgical medical treatment. Results: The transnasal endoscopic technique with folded flaps that we performed in these two patients reduces the risk of restenosis, does not require subsequent reinterventions to remove the stent and generates a better patient tolerance in the postoperative period. As for the use of postoperative azithromycin, the inflammatory process decreased, favoring cicatrization, being able to achieve a correct permeabilization of the choanas and a normal bilateral nasal breathing. Conclusions: We believe that early diagnosis in this type of patients is essential, due to the characteristic of strict nasal breathers presented by the neonates. There were no reports of patients diagnosed in adolescence, so the diagnosis and treatment, in this case, also posed a challenge.

Introdução: a atresia de choana é uma anomalia congênita nasal com incidência de 1 / 70.000 nascidos vivos na Argentina. Esse transtorno/a mesma apresenta dificuldade respiratória desde o nascimento no caso seja bilateral. (Em este estudo) apresentaremos dois casos de pacientes do sexo masculino com atresia de choana bilateral diagnosticada tardiamente. Uma técnica endoscópica trans-septal com aba curvada sem tutores e azitromicina como anti-inflamatório da mucosa respiratória foi utilizada como tratamento pós-cirurgico. Material e método: Foram avaliados de forma descritiva e retrospetiva dois pacientes adolescentes diagnosticados e tratados cirúrgicamente no serviço de Otorrinolaringologia do Hospital Posadas pela técnica transeptal endoscopica sem tutores aba dobrada. São analisados valores como tipo de placa de atresia, idade do diagnóstico, malformações associadas, complicações e resultados cirúrgicos. Como tratamento médico pós-cirúrgico, a azitromicina foi utilizada em dosagens anti-inflamatórias. Resultados: A técnica endoscópica trans-nasal com abas dobradas sem tutor que foi realizada em estes dois pacientes, reduz o risco de re-estenose, não precisando de novas intervenções cirúrgicas para remover o stent e gerar uma melhor tolerância do paciente no pós-operatório. Quanto ao uso de azitromicina pós-operatória, o processo inflamatório diminuiu, favorecendo a cicatrização, conseguindo uma permeabilização correta da choana e uma respiração nasal bilateral normal. Conclusões: Acreditamos que o diagnóstico precoce neste tipo de pacientes é fundamental, devido à característica de respiradores nasais estritos apresentada pelos neonatos. Não houve relatos de pacientes diagnosticados na adolescência, pelo que o diagnóstico e o tratamento, neste caso, também representaram um desafio.

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Introdução: A atresia de coana (AC) é a anomalia nasal congênita mais comum. Estima-se a incidência de 1 caso para cada 8000-10000 nascidos vivos. Relato do caso: Paciente feminina, 9 anos, com obstrução nasal em fossa nasal direita (FND) desde o nascimento. Apresentava roncos e apneia em vigência de infecção de via aérea superior. À rinoscopia anterior direita, secreção hialina abundante. À videonasoendoscopia flexível não foi possível visualizar cavum pela FND, observando-se estase de secreção em região posterior; à esquerda cavum livre, sem lesão expansiva. Tomografia de nariz e seios paranasais evidenciou atresia de coana mista à direita. Foi realizada cirurgia para correção da malformação. Após 30 dias, observou-se reestenose do cavum. Na reintervenção, a coana foi ampliada com remoção do osso palatino e do septo posterior, realizada dilatação com balão e posicionado molde de silicone. Realizada aplicação de Mitomicina. A remoção do molde foi feita em bloco cirúrgico após 42 dias, com permeabilidade coanal preservada. Nasofibroendoscopia após 6 meses mostrou fossas nasais pérvias. Discussão: Ainda há controvérsias na literatura quanto à efetividade das diferentes técnicas cirúrgicas e ao uso de stents e de agentes antineoplásicos no pós-operatório. Neste relato, a dilatação com balão pode ter contribuído para o sucesso da cirurgia, porém o molde foi fundamental para evitar a reestenose. Considerações finais: O uso do molde mostrou um excelente resultado nesta reintervenção de correção de atresia de coana. A baixa reação inflamatória e o sucesso do pós-operatório mostraram que esta é uma opção a ser utilizada para evitar a reestenose (AU)

Introduction: Choanal atresia (CA) is the most common congenital nasal anomaly. Its incidence is estimated as 1 case for every 8,000-10,000 live births. Case report: Female patient, 9 years old, with obstruction in the right nasal cavity (RNC) since birth. She presented snoring and apnea in the presence of upper airway infection. At right anterior rhinoscopy, abundant hyaline secretion. Flexible videonasoendoscopy failed to visualize cavum through RNC, with secretion stasis in posterior region; left cavum free, without expansive lesion. Tomography of the nose and paranasal sinuses revealed mixed choanal atresia on the right. Surgery was performed to correct the malformation. Thirty days later, restenosis of the cavum was observed. At reoperation the choana was enlarged with removal of the palatine bone and posterior septum, balloon dilatation was performed and a silicone cast was positioned. Mitomycin application was performed. Removal of the cast was done in surgical ward after 42 days, with preserved choanal permeability. Nasofibroscopy at 6 months postoperatively showed permeable nasal cavities. Discussion: There is still controversy in the literature regarding the effectiveness of different surgical techniques and the use of stents and anti-neoplastic agents in the postoperative period. In this report, balloon dilatation may have contributed to the success of the surgery, but the cast was crucial to avoid restenosis. Final considerations: The use of the cast had an excellent outcome in this re-intervention of choanal atresia correction. The low inflammatory reaction and postoperative success have shown that this is an effective option to be used to avoid restenosis (AU)

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INTRODUCTION AND OBJECTIVES: Choanal atresia is the most common congenital nasal anomaly. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and different surgical techniques and approaches are used. We describe our experience in transnasal microsurgical treatment of congenital choanal atresia. METHODS: We retrospectively evaluated 49 patients with congenital choanal atresia operated in the Department of Respiratory Endoscopy over a period of 20 years. The clinical variables analysed were type of atretic plate, age at diagnosis and surgery, associated malformations, maternal history of hyperthyroidism treated with methimazole during pregnancy, mode of airway stabilisation before surgery, surgical technique, complications, and outcome. RESULTS: Mixed bilateral choanal atresia was the most frequent (29 cases). Its incidence was higher in females (61.2%). Almost 51% of patients showed associated malformations, and 7 had a history of maternal hyperthyroidism treated with methimazole during pregnancy. The surgical procedure consisted of a transnasal microscopic approach and placement of a silicone endonasal stent for one to 12 weeks. Thirty-five patients required revision after surgery. Nine patients had complications. Suitable nasal ventilation was achieved in 46 patients (93.9%). One patient died of causes unrelated to the surgery. Two patients with permeable choanae remain with tracheotomy. CONCLUSION: The transnasal microsurgical repair with endonasal stent proved to be a safe and effective procedure.

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La atresia de coanas es la alteración congénita más frecuente del desarrollo nasal. Puede ser unilateral o bilateral, y según eso, la clínica puede aparecer desde el momento del nacimiento, o bien permanecerá asintomática hasta la edad adulta. En el neonato, si es bilateral, se manifiesta por una disnea inspiratoria y una cianosis cíclica al lactar, que se alivian con el llanto; y en el adulto, la clínica es de insuficiencia respiratoria nasal unilateral, con rinorrea. El tratamiento es quirúrgico, con varias vías posibles de abordaje, siendo la vía endoscópica la más utilizada hoy en día. La complicación más frecuente tras la cirugía es la reestenosis. Presentamos el caso de una paciente con atresia unilateral, que fue intervenida con éxito en nuestro hospital, y describimos la técnica.

Choanal atresia is the most frecuent congenital anomaly of nasal development. It can be unilateral or bilateral, and according to it, it will give symptoms from the moment of the birth, or will remain asymptomatic up to the adult age. In the newborn it demonstrates for an acute respiratory distress and a cyclic cyanosis by feeding, that relieve with crying; and in the adult, the clinic is of unilateral nasal obstruction, with rhinorhea. The treatment is surgical, with several possible surgical approaches. Transnasal endoscopic repair is the most used nowadays, because it's a safe and successful technique, and reestenosis is the most frequent complication. We present the case of a patient with unilateral atresia, that was operated in our hospital, and we describe the technique used.

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Nasal obstruction in neonates is a potential fatal condition because of their exclusive nasal breathing. The most common congenital causes include choanal atresia, dermoid cyst, glioma and encephalocele. Choanal atresia is the most common congenital nasal anomaly. When bilateral, it presents with respiratory distress at birth. Unilateral atresia is manifested by respiratory failure and unilateral rhinorrhea, and may go along unnoticed. Diagnosis is suspected in the absence of airfow in the nasal cavity and for the inability to advance a nasogastric tube. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and there are different techniques and surgical approaches. We describe our experience with 7 patients with this disease, successfully treated by transnasal endoscopic technique.

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BACKGROUND: Congenital choanal atresia is a rare abnormality characterized by unilateral or bilateral lack of patency of the posterior end of the nasal cavity. With an incidence of 1:5000 to 1:8000 births, it is twice as prevalent in females as it is in males. Surgical procedures aim to provide adequate functional choanal patency and a low rate of restenosis, avoid harm to any structure in development, enable shorter surgery and hospitalization times, and minimize morbidity and mortality. OBJECTIVES: To evaluate the effectiveness and safety of the available surgical techniques for the treatment of congenital choanal atresia in patients with unilateral and bilateral atresia. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the search was 31 January 2011. SELECTION CRITERIA: We planned to include parallel randomized or quasi-randomized controlled trials testing surgical approaches for the treatment of congenital atresia (irrespective of gender and age) that evaluated normal/adequate respiratory function (self reported or preserved nasal airway) and restenosis as the main primary outcomes. We did not consider reoperation and non-congenital atresia (e.g. traumatic, iatrogenic atresias) for inclusion. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed the titles and abstracts of the identified articles to determine potential relevance. For dichotomous and continuous variables, we planned to calculate risk ratios (relative risks; RR) and mean differences (MD) with 95% confidence intervals (CI), respectively. We planned to use the random-effects model since we were expecting substantial clinical and methodological heterogeneity. MAIN RESULTS: No randomized controlled trials were identified. From the 120 reports retrieved using our search strategy, 46 primary studies had the potential to be included since they had tested surgical approaches for choanal atresia. However, we excluded all of them during the final selection process because their study designs did not meet our inclusion criteria. AUTHORS' CONCLUSIONS: There is no definitive evidence, based on randomized controlled trials, to demonstrate the potential advantages and disadvantages of any specific surgical technique for patients with choanal atresia. Specialists should unify their efforts in multicenter randomized controlled trials that test the effectiveness and safety of different surgical techniques in patients with choanal atresia.

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Introdução: A atresia de coanas (AC) pode ser definida como a falha no desenvolvimento da comunicação entre a cavidade nasal e a nasofaringe. Pode ocorrer como uma placa ósteo-membranosa, óssea ou membranosa. O diagnóstico depende de alto grau de suspeição clínica e exames complementares, o tratamento é cirúrgico. Objetivo: Relatar um caso de uma paciente adulta com diagnóstico de atresia coanal bilateral e que foi submetida a tratamento cirúrgico. Relato do Caso: MLSM, 34 anos,sexo feminino, com história de obstrução nasal bilateral, rinorreia hialina desde a infância. Na endoscopia nasal e Tomografia Computadorizada de seios da face evidenciou atresia ósteo-membranosa bilateral. Paciente foi submetida a tratamento cirúrgico endoscópico via transnasal, com confecção de retalho mucoso cobrindo a área cruenta, sem colocação de stent. Foi feito Tomografia de controle que evidenciou coanas abertas e amplas. Paciente evoluiu bem e apresenta respiração nasal normal. Comentários Finais: A AC bilateral, embora rara, pode ocorrer em pacientes adultos...

Introduction: Choanal atresia (CA) can be defined as a failure to develop the communication between the nasal cavity and nasopharynx. May occur as a plate osteo-membranous, bony or membranous. Diagnosis depends on high clinical suspicion and laboratory tests, treatment is surgical. Objective: To report a case of an adult patient diagnosed with bilateral choanal atresia and underwent surgery. Case Report: MLSM, 34 years old female with a history of bilateral nasal obstruction, rhinorrhea hyaline since childhood. On nasal endoscopy and CT scan of the sinuses showed bilateral membranous atresia osteo. Patient underwent endoscopic transnasal route, with production of mucosal flap covering the wound, without stent placement. Tomography was performed which showed control choanae open and broad. The patient progressed well and has normal nasal breathing. Conclusion: AC bilateral, although rare, can occur in adult patients...

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La atresia de coanas, es una patología poco frecuente, que habitualmente se diagnostica en las edades tempranas. Representa un reto quirúrgico por su alta tendencia a la reestenosis, considerándose en la actualidad de elección el tratamiento endoscóplco. Tratamientos como stents posoperatorios o la aplicación de mitomicina C tópica para disminuir la reestenosis son todavía controvertidos, sin que exista consenso. Presentamos el caso de un adulto con atresia de coana unilateral que se reparó vía endoscópica transnasal y se realiza una revisión bibliográfica sobre el estado actual del tratamiento de esta patología.

Choanal atresia is a very rare condition, usually it's diagnosticated in early age. It represents a surgical challenge for the high tendency to restenosis, being actually the endoscopic treatment first option. Other treatments like postoperative stents or topical mitomycin-C in order to avoid restenosis are controversial, and there is a lack of consensus. We present an adult case with unilateral choanal atresia treated by transnasal endoscopic technique and It's carry out a bibliographical review about the current treatment state of this pathology.

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RESUMEN

Se realizó un estudio transversal y retrospectivo sobre los 11 pacientes atendidos en el Servicio de Otorrinolaringología del Hospital infantil Sur de Santiago de Cuba con el diagnóstico de imperforación de coanas, donde se expone la experiencia del equipo médico en el tratamiento de estos niños durante más de 30 años de trabajo (1970-2000)(AU)

A retrospective and cross-sectional study was conducted in 11 patients diagnosed with imperforate choanas, who were attended in the Otorhinolaringology Service of the Southern Children Hospital from Santiago de Cuba, where the experience of the medical team in the treatment of these children for more than 30 working years (1970-2000) is stated(AU)

Asunto(s)

RESUMEN

Se realizó un estudio transversal y retrospectivo sobre los 11 pacientes atendidos en el Servicio de Otorrinolaringología del Hospital infantil Sur de Santiago de Cuba con el diagnóstico de imperforación de coanas, donde se expone la experiencia del equipo médico en el tratamiento de estos niños durante más de 30 años de trabajo (1970-2000).

A retrospective and cross-sectional study was conducted in 11 patients diagnosed with imperforate choanas, who were attended in the Otorhinolaringology Service of the Southern Children Hospital from Santiago de Cuba, where the experience of the medical team in the treatment of these children for more than 30 working years (1970-2000) is stated.

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