CHOANAL

ATRESIA
 Historical Background

• In 1755, Roederer first described congenital

choanal atresia; therefore, this condition
has been recognized for more than 200
years.
• .
 DEFINITION
Developmental failure of the nasal cavity to
communicate with the nasopharynx.
• Rare congenital anomily

• 1 in 5000 to 8000 live births

• Female male ratio is 2:1

 Epidemiology
• Occurs in ~1 in 5,000 – 7,000 live births

• More common in girls than boys

• Slightly increased risk exists in twins.

• Maternal age or parity does not increase the

frequency of occurrence.
• Chromosomal anomalies are found in 6%
of infants with choanal atresia.
•
• Choanal atresia occurs with equal
frequency in people of all races
 ASSOCIATIONS
CHARGE ASSOCIATION
• Coloboma
• Heart disease
• Atresia of choanae
• Retarded G and D
• Genital hypoplasia
• Ear deformities or deafness
 EMBRYOGENESIS
• Theory 1
• Hochstaller or buccopharyngeal
membrane from foregut

• Rupture of membrane 5 -6 week of

gestation

• Forms choanae
• Theory 2
• Abnormal persistence of mesoderm
• Adhesions of the region
• Atesia
 Etiology
• By the 38th day of development, the 2-layer
membrane consisting of nasal and oral epithelia
ruptures and forms the choanae (posterior nares).
• Failure of this rupture results in choanal
atresia.

• In 2008, Barbero et al suggested that

prenatal use of antithyroid (methimazole,
carbimazole) medications was linked to
choanal atresia.
 TYPES
UNILATERAL

BILATERAL
 TYPE 2
• BONY MIXED
 TYPES
• CONGENITAL

• ACQUIRED
 Clinical manifestations
BILATERAL
• Complete nasal obstruction
• Immediate respiratory distress
• Potential death due to asphyxia
• Cyclic respiratory obstruction
• Child cries opens the mouth
• obstruction is relieved
 UNILATERAL
• Rarely causes respiratory distress
• Mucoid discharge

• OTHER MANIFESTATIONS
• Feeding difficulty
• Respiratory collapse
• Failure to thrive
 DIAGNOSIS
• Physical examination
• Passing of a feeding tube through nose
• Observing misting on a metal spatula or
laryngeal mirror

• Placing methylene blue in nasal cavity

• Endoscopic examination
RADIOGRAPHY
 Acoustic rhinometry

• new technique which evaluates nasal

obstruction by analysing reflections of a
sound pulse introduced via the nostrils.
Computed tomography
 Diagnosis Confirmation
• Confirmed with
CT with intranasal
contrast that
shows narrowing
of the posterior
nasal cavity
 MANAGEMENT
• IMMEDIATE MANAGEMENT
• Breathe through mouth
• Mc govern nipple
• Oropharyngeal airway
Mc Govern nipple
Oropharyngeal airway
ENDOTRACHEAL
INTUBATION
TRACHEOSTOMY
UNILATERAL
 SURGICAL REPAIR
• TRANSNASAL APPROACH

• TRANSPALATAL APPROACH
TRANSNASAL APPROACH
TRANSPALATAL APPROACH-
STENT PLACEMENT
 ENDOSCOPIC
CHOANOPLASTY WITHOUT
STENT PLACEMENT
 COMPLICATIONS
• INFECTIONS
• BLEEDING
• GROWTH PROBLEMS
• SCARRING
• RESTENOSIS
 NURSING MANAGEMENT
• Assessment
• Diagnosis
• Planning
• Intervention
• Evaluation