Combined transoral-transnasal approach in the repair of congenital posterior choanal atresia: clinical experience.

BACKGROUND: A myriad of techniques have been described for managing posterior choanal atresia over the years, yet no standardized surgical protocol has been established.

OBJECTIVE: To present our experience with the transoral-transnasal approach for repairing posterior choanal atresia.

PATIENTS AND METHODS: A prospective study of children with posterior choanal atresia treated at Ain Shams University Hospitals from 2006 to 2010. Thirteen children affected by this malformation underwent a transoral-transnasal approach by the authors using a standardized surgical technique. All patients were followed up for a period ranging from 6 months to 3 years. Stents were used in neonates, and topical mitomycin C was applied in follow-up when cases needed further dilatation after the first intervention.

RESULTS: Patient demographics were obtained. Stents were used in 11 cases, and mitomycin C was used in 9 cases. Complications were as follows: 1 case had palatal perforation that healed spontaneously, 2 cases had restenosis and were lost to follow-up, and of the other 11 cases, 3 needed no further management and 8 cases needed further dilatation.

CONCLUSION: The aforementioned combined transoral-transnasal technique provides a good alternative for managing posterior choanal atresia with easier, four-handed surgery to ensure adequate posterior choana for nasal breathing, but it usually needs multiple sessions.