Surgical Management of Choanal Atresia
Improved Outcome Using Mitomycin
Bradford W. Holland, MD;
William F. McGuirt, Jr, MD
Arch Otolaryngol Head Neck Surg. 2001;127:1375-1380.
Objective To evaluate the intraoperative use of mitomycin to improve the surgical
outcome and reduce the rate of soft tissue restenosis in children undergoing
choanal atresia repair.
Design Retrospective chart review of all patients surgically treated for congenital
choanal atresia by the senior author (W.F.M).
Setting Tertiary children's hospital.
Patients Eight consecutive patients with bony choanal atresia (6 unilateral and
2 bilateral) were compared with 15 historical controls (6 unilateral and 9
bilateral). All study and historical control patients were treated with soft
plastic postoperative stenting.
Intervention At the completion of the surgical repair of the choanal atresia, 0.4
mg/mL of topical mitomycin was applied to the posterior choanae for 3 minutes.
Main Outcome Measure The success rate of the repair of the choanal atresia as determined
by the postoperative need for dilation or revision surgical procedures was
compared with that of the historical controls.
Results All 8 children with intraoperative use of mitomycin were treated with
a mean ± SEM of 0.375 ± 0.183 dilations per patient. The 15
children in the control group received a mean ± SEM of 3.667 ±
0.583 postoperative dilations for soft tissue restenosis. The difference in
the number of postoperative dilations between the study and control group
was statistically significant (P = .006) using a t test.
Conclusions Mitomycin is an effective and reliable treatment for improving the surgical
outcome for choanal atresia repair. This may obviate the need for postoperative
dilations and may potentially eliminate the need for surgical stenting.
From the Department of Otolaryngology, Wake Forest University School
of Medicine, Brenner Children's Hospital, Winston-Salem, NC.
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