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Qin ying Wang, MD; Liang Chai, MD; Shen qing Wang, MM; Shui hong Zhou, MD; Yu yu Lu, MM

Arch Otolaryngol Head Neck Surg. 2009;135(5):462-466.

Objectives  To examine the clinical effects of temperature-controlled radio frequency (TCRF) repair of acquired choanal stenosis and atresia with the aid of an endoscope and to discuss the value of acquired choanal stenosis and atresia typing in clinical therapy.

Design  Retrospective study.

Setting  Academic otorhinolaryngologic referral center.

Patients  Thirty-two patients, aged 32 to 65 years, with acquired choanal stenosis and atresia (from trauma in 9 cases and from radiotherapy after nasopharyngeal carcinoma in 23 cases); 13 cases were bilateral, and 19 were unilateral.

Interventions  Transnasal TCRF repair with the aid of an endoscope. Acquired choanal stenosis and atresia can be divided into 3 types: type 1, diagnosed within 3 months of the causative trauma or radiotherapy; type 2, diagnosed between 3 and 6 months after the trauma or radiotherapy; and type 3, diagnosed more than 6 months after the trauma or radiotherapy. All patients with types 1 and 2 disease received nasal stents made from Silastic that were fixed with transseptal sutures. However, patients with type 3 disease received no stenting.

Main Outcome Measures  The thickness of the stenosis and atresia revealed by computed tomographic scan and the surgical results were also analyzed. There was no significant correlation between them (P > .05).

Results  Twenty-nine patients remained free of symptoms for 12 to 42 months after surgery. Three patients required revision surgery, including 2 cases of type 1 disease (3 sides) and 1 case of type 2 (1 side). Two of the patients who underwent revision recovered completely, with no restenosis at 12 months after the second surgery. However, 1 patient with type 1 bilateral atresia experienced another restenosis and required another revision, through a transpalatal approach. There were no postoperative complications. There was no significant correlation between thickness of the stenosis revealed by computed tomographic scan and the surgical results.

Conclusions  We describe a TCRF technique with the aid of an endoscope for choanal repair. In our experience, it has been a highly successful, safe, and effective procedure, with minimal blood loss, swift recovery, and short time of hospitalization. It is important in postoperative care to remove any granulation or polyps at the site of the neochoana. Types 2 and 3 are the best types of disease to treat with this procedure.

Author Affiliations: Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

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