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Transnasal Endoscopic Treatment of Choanal Atresia Without Prolonged Stenting
Thierry Van Den Abbeele, MD, PhD;
Martine François, MD;
Philippe Narcy, MD
Arch Otolaryngol Head Neck Surg. 2002;128:936-940.
Objective To analyze the outcome of transnasal endoscopic repair of choanal atresia
(CA) in children without prolonged nasal stenting after surgery.
Design Retrospective study.
Setting Academic tertiary care children's hospital.
Patients Forty children aged 3 days to 15 years (mean age, 41 months) who presented
with unilateral (n = 26) or bilateral (n = 14) CA and underwent surgery between
August 1996 and December 1999.
Intervention All children underwent transnasal endoscopy with telescopes, endoscopic
instruments, and a microdebrider. Nasal tubes in neonates or infants and nasal
packing in older children were always removed after 2 days. Systematic revision
endoscopy was performed with the patients under local or general anesthesia
on days 6 to 10. All patients were then clinically and endoscopically monitored
for nasal obstruction and healing during a mean follow-up period of 18 months.
Results There were 16 patients with associated malformations, including 6 cases
of CHARGE association (a malformative syndrome that includes coloboma, heart
disease, CA, retarded development, genital hypoplasia, and ear anomalies,
including hypoplasia of the external ear and hearing loss), and 14 patients
(9 with bilateral CA) with a history of previous choanal surgery (4 transnasal,
4 laser, and 6 transpalatine). Postoperatively, 32 patients (80%) had normal
nasal patency and a satisfactory choanal diameter, and 8 (20%) had restenosis
or complete choanal closure. Six underwent a second procedure, with success.
The results in all children who had been previously treated with laser or
transpalatine surgery were successful. The last patient, who presented with
severe Treacher Collins syndrome, is still tracheotomized. There were no significant
postoperative complications. One patient died of congenital cardiopathy 6
months after surgery.
Conclusions Transnasal endoscopic repair of CA is a safe and successful technique.
The use of powered instrumentation and routine postoperative revision endoscopy
seems to avoid prolonged nasal stenting.
From the Department of Pediatric Otorhinolaryngology, Robert Debré
Hospital, Paris, France.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Predictive Factors for Success After Transnasal Endoscopic Treatment of Choanal Atresia
Teissier et al.
Arch Otolaryngol Head Neck Surg 2008;134:57-61.
ABSTRACT
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