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Yılmaz Topçuoğlu MS, Hammitsch-Mayer A, Plinkert PK, Baumann I. [Choanal atresia repair in Germany : Resection of dorsal septal parts and stents in focus]. HNO 2024; 72:199-203. [PMID: 38189815 PMCID: PMC10879300 DOI: 10.1007/s00106-023-01410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Various surgical techniques using transpalatinal, transseptal, and transnasal approaches for surgical repair of choanal atresia have been developed over the past 200 years. Endoscopic endonasal surgery with resection of dorsal septal parts and without the use of stents is the current scientific trend, as high success rates with low complication rates can be achieved. This study examined whether this technique has actually become standard in Germany, and also investigates the role played by stents. METHODS A total of 52 ear, nose, and throat (ENT) hospitals in Germany, including all 39 university ENT hospitals and 13 non-university maximum-care ENT hospitals, were asked which surgical technique they use for choanal atresia repair and whether stents are used. RESULTS For dorsal septal resection, 39 of 44 responding hospitals (89%) indicated that they resect dorsal septal parts, 85% of the university hospitals and 100% of the non-university hospitals. For use of stents, 20 of 48 responding hospitals (42%) reported not using stents, whereas 39% of the university hospitals and 50% of the non-university hospitals do use them. CONCLUSION Endoscopic endonasal choanal atresia repair with resection of dorsal septal parts is, in most instances, used as the standard technique in large ENT hospitals in Germany. Routine use of stents is still widespread. The future aim should be to reduce the use of stents in the treatment of choanal atresia and to use this method only in difficult, individual cases.
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Affiliation(s)
- Miray-Su Yılmaz Topçuoğlu
- Hals‑, Nasen- und Ohrenklinik, Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Antje Hammitsch-Mayer
- Praxis für Gynäkologie und Geburtshilfe Dr. med. Ulrike Steinhoff, Berlin, Deutschland
| | - Peter K Plinkert
- Hals‑, Nasen- und Ohrenklinik, Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Ingo Baumann
- Hals‑, Nasen- und Ohrenklinik, Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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van Schaik CGR, Paasch S, Albrecht T, Becker S. Treatment of choanal atresia in a cohort of 29 patients: Determinants for success or failure. Int J Pediatr Otorhinolaryngol 2022; 160:111240. [PMID: 35868110 DOI: 10.1016/j.ijporl.2022.111240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Choanal Atresia is a congenital condition that presents as a blockage from the nasal cavity to the nasopharynx. According to the German statistical Institute (Statistisches Bundesamt), the incidence in Germany in 2018 reached 2.74 in 10,000 live births. It can present unilaterally or bilaterally. As newborns are obligate nasal breathers, management of bilateral atresia has to be performed early after birth. As for unilateral atresia, the optimal age for treatment was determined to be between 6 and 12 months in a recently published consensus. OBJECTIVE The main purpose of this study is to characterize the patients treated for choanal atresia in the Department of Otorhinolaryngology and Head and Neck Surgery at a tertiary hospital in the south of Germany and, based in the demographic characteristics as well as intra- and post-operative treatment, to identify factors for success or failure of the surgery. A secondary goal was to describe the complications in the use of stents and analyse its influence in the results. MATERIAL AND METHODS The cohort-based observational study included 29 patients, with a minimum follow up of one year, who underwent surgical endoscopic correction of both unilateral and bilateral choanal atresia from 2003 to 2020. Analysis of the demographics, intraoperative, and postoperative treatment, and their results, was performed. Multinomial logistic regression was applied for categorical values. Comparisons were performed using Fischer/chi-square test where applicable. A significance level of 0.05 was reached. RESULTS The population was comprised of 34.5% male and 65.5% female patients. The age varied from 2 days to 20 years old, with a mean of 4.98 years and Standard Deviation (SD) 6.88. The weight of the patients varied between 1.4 kg and 85.0 kg, with a mean of 19.36 and SD 22.58. Unilateral choanal atresia was present in 58.6%, and bilateral in 41.4%. Out of this population, 48.3% presented with associated malformations. The number of procedures per patient performed in general anesthesia varied from 1 to 9, with a mean of 2.52 and SD of 2.23: statistically higher for patients presenting with bilateral atresia with a p value of 0.001*. 20 patients had a tube (Vygon, France) placed at first surgery. In 5 patients, a drug-eluting stent (Propel mini (R); Intersect ENT, USA) was applied intraoperatively, without complications. In unilateral choanal atresia, surgical and functional success was attained in 88.2% of the cases. In bilateral cases, it reached 75%. We observed a strong linear relationship between the weight of the patient and the size of the choana perioperatively: R quadrat 0.596, which may be a determinant factor in the wound healing. Weight, age, and concomitant pathology achieved statistical significance in the logistic regression model (p respectively 0.001*, 0.001* and 0.010*), which shows its influence in the result of the surgery. In particular, weight inferior to 3 kg (p 0.001*, chi-square test) at the time of the first surgery is a determinant demographic factor for need of revision in order to achieve patency. There were no major complications associated with the use of a stent, besides its dislodgement. We could not infer an implication of its use on the success of the surgery in the present cohort. LIMITATIONS for this study were the small size of the cohort and non-standardized records for some variables. CONCLUSIONS Younger patients presenting with low weight and concomitant pathology have worse results after surgical endoscopic treatment of choanal atresia, revealing these characteristics to be determinant for success. The size of the neochoana is related to the weight of the patient, which is a limiting factor. In particular, patients under 3 kg had to undergo more procedures in order to achieve patency. The implication of the use of locally applied medication needs to be further studied.
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Affiliation(s)
| | - Steffen Paasch
- Department of Otorhinolaryngology, Head and Neck Surgery, Tübingen University Hospital, Germany
| | - Tobias Albrecht
- Department of Otorhinolaryngology, Head and Neck Surgery, Tübingen University Hospital, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, Tübingen University Hospital, Germany
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Endoscopic Endonasal Repair of Congenital Choanal Atresia: Predictive Factors of Surgical Stability and Healing Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159084. [PMID: 35897454 PMCID: PMC9329715 DOI: 10.3390/ijerph19159084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022]
Abstract
Background: To assess the long-term outcomes and independent predictors of surgical success of a one-stage minimally invasive surgical procedure for congenital choanal atresia (C.C.A.). Methods: a retrospective multicentric study was conducted between 2010 and 2022. An endonasal endoscopic approach was performed in 38 unilateral or bilateral C.C.A. children. All the patients were clinically and radiologically assessed and followed for at least 2 years. Seven outcome measures were applied. Consequently, surgical success was correlated with all the independent variables reported. Results: 18/38 (47.36%) patients presented normal postoperative healing, 8/38 (21.05) had moderate restenosis (<50%), while 12/38 (31.57%) cases were severe (>50%), requiring a surgical revision. No statistical significance was found for average hospital stay between stenosis >50% and <50% patients (p = 0.802) and postoperative pain (p = 0.075); instead, the severe restenosis group demonstrated a higher delay of breast suction (p < 0.001). Among the independent variables predictors of surgical success, the presence of Charge syndrome and rhinopharyngeal stenosis demonstrated higher risks for surgical revision (OR: 4.00, 95% CI: 0.57−28.01, and OR: 2.75, 95% CI: 0.55−13.69, respectively). On the contrary, the hypoplastic inferior turbinate and bilateral C.C.A. showed a lower risk for severe restenosis by a higher endoscopic surgical space and creating a single larger opening (OR: 0.88, 95% CI: 0.22−3.52, and OR: 0.45, 95% CI: 0.10−2.08). Conclusion: Several independent variables could influence the surgical success after C.C.A. endoscopic repair; however, more high-quality evidence is needed to generate an effective predictive model.
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Rossi NA, Benavidez M, Pine HS, Daram S, Szeremeta W. Surgical Management of Choanal Atresia: Two Classic Cases and Review of the Literature. Cureus 2022; 14:e24259. [PMID: 35607544 PMCID: PMC9123360 DOI: 10.7759/cureus.24259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/26/2022] Open
Abstract
Choanal atresia is a rare congenital airway malformation that presents a unique surgical challenge for pediatric otolaryngologists. Here we report two classic cases of choanal atresia and examine the surgical approaches to this entity. The first case was a four-day-old female with a history of CHARGE syndrome and bilateral mixed membranous and bony choanal atresia confirmed by a CT scan. After undergoing transnasal endoscopic repair, choanal stents were placed for four weeks, and the patient was seen three months postoperatively and found to be doing well with no respiratory concerns. The second case involved a healthy three-year-old female presenting with unilateral combined membranous and bony atresia. Following successful endoscopic repair, she was seen at a three-month follow-up with no signs of restenosis. Additionally, a literature review was performed to evaluate updates since the 2012 Cochrane Review on surgical treatment of congenital choanal atresia.
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Galletti C, Freni F, Ciodaro F, Galletti B. Congenital bilateral choanal atresia: an endoscopic approach with multi-flaps supported by neuronavigated CT. BMJ Case Rep 2021; 14:e245815. [PMID: 34728511 PMCID: PMC8565542 DOI: 10.1136/bcr-2021-245815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 2-month-old patient with CHARGE syndrome, cerebral haemorrhage and bilateral congenital choanal atresia (CCA). He was admitted to our otorhinolaryngology unit to solve his congenital bilateral choanal atresia proposing a transnasal endoscopic surgery. A study of CT of the skull showed that the air column was interrupted on both sides of nasal cavities; a nasal endoscopy with neonatology flexible optics showed the presence of a membrane and bony structure obstructing the passage into the nasopharynx. Preoperative brain magnetic resonance (MRN) has been made. We decided to carry out a transnasal endoscopic neuronavigation approach with multi-flaps without stenting apposition to solve the CCA, using a 0° 2.7-millimetre rigid endoscopic and Skeeter-type drill with a 2.3-millimetre microblade cutter. Postoperative nasal care was essential to avoid recurrences. Endoscopic follow-up was performed; a large uni-neochoane was residual at 3 months, all raw surfaces were covered by multiple mucosal flaps welded with fibrin.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
| | | | - Bruno Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
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Features and Strategies in the Management of Choanal Atresia: A 6-Year Retrospective Analysis. J Craniofac Surg 2021; 32:e535-e539. [PMID: 33770044 DOI: 10.1097/scs.0000000000007490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Choanal atresia although rare, is the most common inborn nasal deformity and an important cause of newborn airway obstruction. This study aims to describe a single-center experience in the management of choanal atresia and emphasize the ambiguous issues regarding its surgical repair. PATIENTS AND METHODS The authors retrospectively analyzed the treatment strategy of 18 patients with choanal atresia and their outcomes during the follow-up period. RESULTS Bilateral choanal atresia was diagnosed in 9 patients, 6 of those had mixed bony-membranous type (67% versus 33% who had pure bony type). Almost half of the 18 patients had a mixed bony-membranous type of atresia (56%). Interestingly, 89% of patients with bilateral atresia underwent transnasal endoscopic repair with stenting, compared to 44% of those with unilateral atresia (P = 0.04). A trend to preference of stent procedure in patients with bony type was also observed, in comparison with mixed bony-membranous type (89% versus 50%, P = 0.09). No significant difference in the need for revision treatment was noticed among the two treatment groups. CONCLUSIONS Both in our data and literature there is no clear supremacy of stenting. Considering the high incidence of re-stenosis, all patients should be under close follow up for a long-term period. Inevitably, further investigation is necessary to establish an ideal surgical procedure.
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Sutikno B, Thaufiqurrakhman M. Transnasal endoscopic neochoanal technique: An effective procedure for bilateral choanal atresia in adult female. Int J Surg Case Rep 2021; 86:106338. [PMID: 34454213 PMCID: PMC8405973 DOI: 10.1016/j.ijscr.2021.106338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022] Open
Abstract
Background Surgery on bilateral choanal atresia surgery is challenging and this case is rare in adults. In addition, stenosis issue postoperatively is commonly seen. Case presentation Transnasal endoscopic neochoanal technique was performed on a 27 years old female with the detailed surgical procedure was described. Neither stent nor nasal tamponade was applied. Ten months follow-up revealed a patent-wide neochonae. Discussion Transnasal endoscopic neochoanal technique without stent and nasal tamponade can be considered the procedure of choice in the management of CA cases. Conclusions Transnasal endoscopic neochoanal technique is considered an effective surgical procedure on bilateral choanal atresia. Choanal atresia in adults is often related to the socioeconomic status of the patient. The transnasal endoscopic neochoanal technique is an effective procedure for choanal atresia. Low socioeconomic status may cause a delay in diagnosis and thus management of choanal atresia.
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Affiliation(s)
- Budi Sutikno
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Muhammad Thaufiqurrakhman
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Baldovin M, Cazzador D, Zanotti C, Frasson G, Saratziotis A, Pagella F, Pelucchi S, Emanuelli E. Bilateral Choanal Atresia and Endoscopic Surgery: A Chance for CHARGE Patients. J Clin Med 2021; 10:jcm10132951. [PMID: 34209160 PMCID: PMC8269040 DOI: 10.3390/jcm10132951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/07/2021] [Accepted: 06/26/2021] [Indexed: 11/16/2022] Open
Abstract
Bilateral choanal atresia (CA) is a rare congenital malformation frequently associated with other anomalies. CHARGE association is closely linked to bilateral CA. The aim of this study was to describe the outcomes of the endoscopic repair in bilateral CA, and to assess the role of postoperative nasal stenting in two cohorts of CHARGE-associated and non-syndromic CA. Thirty-nine children were retrospectively analyzed (16 patients had CHARGE-associated CA). The rate of postoperative neochoanal restenosis was 31.3% in the CHARGE population, and 47.8% in the non-syndromic CA cohort. Data on postoperative synechiae and granulation tissue formation, need for endonasal toilette and dilation procedures, and number of procedures per patient were presented. Stent positioning led to a higher number of postoperative dilation procedures per patient in the non-syndromic cohort (p = 0.018), and to a higher rate of restenosis both in the CHARGE-associated, and non-syndromic CA populations. Children with CHARGE-associated and non-syndromic bilateral CA benefitted from endonasal endoscopic CA correction. The postoperative application of an endonasal stent should be carefully evaluated.
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Affiliation(s)
- Maria Baldovin
- Department of Neurosciences, Section of Otorhinolaryngology, University of Padova, 35128 Padova, Italy; (D.C.); (C.Z.); (E.E.)
- Correspondence: ; Tel.: +39-049-821-8776
| | - Diego Cazzador
- Department of Neurosciences, Section of Otorhinolaryngology, University of Padova, 35128 Padova, Italy; (D.C.); (C.Z.); (E.E.)
| | - Claudia Zanotti
- Department of Neurosciences, Section of Otorhinolaryngology, University of Padova, 35128 Padova, Italy; (D.C.); (C.Z.); (E.E.)
| | - Giuliana Frasson
- Unit of Otorhinolaryngology, Ospedale di Cittadella, 35013 Cittadella, Italy;
| | - Athanasios Saratziotis
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larissa, 41110 Larissa, Greece;
| | - Fabio Pagella
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, 27100 Pavia, Italy;
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Enzo Emanuelli
- Department of Neurosciences, Section of Otorhinolaryngology, University of Padova, 35128 Padova, Italy; (D.C.); (C.Z.); (E.E.)
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Choanal atresia surgery: outcomes in 42 patients over 20 years and a review of the literature. Eur Arch Otorhinolaryngol 2021; 278:2347-2356. [PMID: 33386964 DOI: 10.1007/s00405-020-06506-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Choanal Atresia (CA) is potentially life-threatening and its repair has a variable revision rate. OBJECTIVES A case series study from 1997 to 2017 to evaluate the results of repair of CA and review factors affecting outcome. METHODS Forty-two patients aged one day to 16 years were included. The outcome measures were the number of revision operations and the length of time over which surgery was required. A focused review of the recent literature (2000-2018) was done. RESULTS Bilateral cases (17) had a mean of 5.24 operations compared to 2.2 operations in unilateral cases (25). Nine patients had bony CA and required 3.56 operations, twenty-four patients had mixed CA and required 3.58 operations. Twelve patients with comorbidities required more operations. Patients with reflux disease required a mean of 4.67 operations. CONCLUSION An increased rate of restenosis was found in patients with bilateral CA, GERD and those with comorbidities. Parents should be counselled regarding the likelihood of revision surgery. Use of stents or Mitomycin C did not impact the revision rate in this series.
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Bartel R, Levorato M, Adroher M, Cardelus S, Diaz A, Lacima J, Vazquez C, Veneri A, Wienberg P, Claveria M, Haag O. Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Koppen T, Bartmann D, Jakob M, Bootz F, Müller A, Dresbach T, Send T. Diagnostics and therapy of bilateral choanal atresia in association with CHARGE syndrome. J Neonatal Perinatal Med 2020; 14:67-74. [PMID: 32741782 DOI: 10.3233/npm-200450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bilateral choanal atresia in patients with CHARGE syndrome becomes symptomatic immediately after birth. A prompt diagnosis, the implementation of sufficient preliminary measures, and the delivery of surgical therapy are crucial. This article is intended to assist in terms of diagnostics and a therapy recommendation. METHODS We performed a retrospective study using the medical records of all newborns in the University Hospital in Bonn, diagnosed with bilateral choanal atresia and CHARGE syndrome and underwent surgery at the Department of Otorhinolaryngology, Head and Neck Surgery. RESULTS A total of 21 patients have been treated with a unilateral or bilateral choanal atresia. 14 patients were primarily treated with transnasal endoscopy or underwent transnasal endoscopic surgery as a follow-up intervention (73.68%). Nine patients had a syndromal appearance, which was considered a definite diagnosis in six patients (five with CHARGE syndrome). All five patients with CHARGE syndrome received transnasal endoscopic treatment and a stent was inserted. DISCUSSION Bilateral choanal atresia can be a life-threatening situation requiring acute measures. The therapeutic trend goes towards transnasal endoscopic resection. Primary intervention should be: minimally invasive, one-stage surgery, functional, and associated with low complication rates. Patency can be increased by saline irrigations, topical corticosteroids, endoscopic controls, and regular dilatation. The insertion of stents is controversially discussed but can be useful in syndromal patients. However, adjuvant therapy with a stent and mitomycin C is increasingly being abandoned. A significantly higher recurrence rate must be expected in association with CHARGE syndrome. Stenting should be considered on an individual basis. Continuous training and support of the parents are obligatory.
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Affiliation(s)
- T Koppen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany
| | - D Bartmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany
| | - M Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Germany
| | - F Bootz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany
| | - A Müller
- Neonatology and Pediatric Intensive Care, Children's Hospital, University Hospital Bonn, Germany
| | - T Dresbach
- Neonatology and Pediatric Intensive Care, Children's Hospital, University Hospital Bonn, Germany
| | - T Send
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany
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Wilcox LJ, Smith MM, de Alarcon A, Epperson M, Born H, Hart CK. Use of Steroid-Eluting Stents after Endoscopic Repair of Choanal Atresia: A Case Series with Review. Ann Otol Rhinol Laryngol 2020; 129:1003-1010. [PMID: 32468891 DOI: 10.1177/0003489420928374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE(S) To describe a single institution's experience with the use of steroid-eluting stents after endoscopic transnasal repair of choanal atresia. METHODS A case series with review of children who underwent choanal atresia repair at a tertiary children's hospital from June 2017 to January 2018 was performed. Those who had a mometasone drug-eluting stent (Propel® Mini, Intersect ENT Inc., Palo Alto, CA) placed after primary or secondary choanal atresia repair at our institution were included. The primary outcome measure was need for revision surgery due to stenosis. Postoperative regimens, duration of stenting, and need for return to the operating room (OR) were also assessed. RESULTS Five patients with a median age of 22 months at the time of repair met inclusion criteria. Two (40%) had bilateral atresia and 3 (60%) had confirmed CHARGE syndrome. A total of 6 mometasone drug-eluting stents were used in the 5 cases. Three patients were reassessed at least once in the OR; however, the majority (57.1%) of postoperative evaluations were able to be performed in the office or bedside setting. The first and last evaluations occurred a mean of 14 and 124 days after surgery, respectively. There were no instances of restenosis, repeat surgical interventions, or stent-related complications noted. CONCLUSION Placement of a mometasone drug-eluting stent is a promising method to improve postoperative results and management of choanal atresia repair by limiting the need for repeat anesthetics and OR procedures, as well as the complications of traditional stents.
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Affiliation(s)
- Lyndy J Wilcox
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew M Smith
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Madison Epperson
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hayley Born
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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13
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Bartel R, Levorato M, Adroher M, Cardelus S, Diaz A, Lacima J, Vazquez C, Veneri A, Wienberg P, Claveria MA, Haag OH. Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:51-56. [PMID: 32439138 DOI: 10.1016/j.otorri.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/07/2020] [Accepted: 01/19/2020] [Indexed: 01/15/2023]
Abstract
Endoscopic repair of congenital choanal atresia is the gold standard surgical treatment today. Though several controversies on treatment have been reported, surgical techniques for better outcomes are still in discussion. The objective of this study is to evaluate the performance of endoscopic choanal atresia repair with endonasal flaps and no stents. Publications in English in the last 5 years were searched in the PUBMED database and were systematically reviewed. A total of 9 articles were included according to the inclusion criteria, obtaining a total of 266 patients managed for congenital choanal atresia with endoscopic surgery, endonasal flaps, and no stents. Surgical results, type of atresia, atresia laterality, associated pathologies and follow up were evaluated. Successful surgery was obtained in 237 (89%) patients while 29 (11%) patients required a new surgical intervention during the follow-up period. Fourteen percent of the patients were diagnosed with CHARGE syndrome and 5% of the patients had some associated heart disease. Bony-Membranous stenosis was observed in 74% of the patients, while a total bony obstruction was recognized in 26% of the patients. Unilateral atresia was observed in 37% of the cases and 63% of the cases had bilateral atresia. The mean follow-up period was 39.5 months (range 3-168 months). An important functional success rate can be accomplished by correcting congenital choanal atresia using functional endoscopic surgery, covering raw areas with endonasal vascularized flaps, avoiding postoperative endonasal stenting.
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Affiliation(s)
- R Bartel
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain.
| | - M Levorato
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - M Adroher
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - S Cardelus
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - A Diaz
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - J Lacima
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - C Vazquez
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - A Veneri
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - P Wienberg
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - M A Claveria
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
| | - O H Haag
- Otolaryngology Department, Barcelona Children's Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Catalonia, Spain
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14
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Ceylan SM, Erdoğan C, Sozen T, Kanmaz MA, Disikirik I, Jafarov S, Tahir E. The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation. EAR, NOSE & THROAT JOURNAL 2019; 100:483S-488S. [PMID: 31625404 DOI: 10.1177/0145561319882123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients' subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups (P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.
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Affiliation(s)
- Seyit Mehmet Ceylan
- Department of Otorhinolaryngology, School of Medicine, 390721SANKO University, Gaziantep, Turkey
| | - Ceren Erdoğan
- Department of Ophtalmology, Duztepe Yasam Hospital, Gaziantep, Turkey
| | - Tevfik Sozen
- Department of Otorhinolaryngology, School of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Mahmut Alper Kanmaz
- Department of Otorhinolaryngology, School of Medicine, 390721SANKO University, Gaziantep, Turkey
| | - Ilyas Disikirik
- Department of Ear Nose Throat Disease, Sani Konukoglu Hospital Practice and Research Center, Gaziantep, Turkey
| | - Shamkhal Jafarov
- Department of Ophtalmology, Duztepe Yasam Hospital, Gaziantep, Turkey
| | - Emel Tahir
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey
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15
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Shay SG, Valika T, Chun R, Rastatter J. Innovations in Endonasal Sinus Surgery in Children. Otolaryngol Clin North Am 2019; 52:875-890. [PMID: 31353137 DOI: 10.1016/j.otc.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although there have been many advances in new tools and procedures for endonasal sinus surgery in children, the management and care for pediatric chronic rhinosinusitis has remained relatively unchanged. However, there have been advances in skull base surgery and tumor removal and new knowledge about perioperative concerns in children. This article discusses the role and risks of endoscopic sinus surgery, the use of balloon sinuplasty in children, management of complicated rhinosinusitis, and advances in skull base tumors and choanal atresia repair.
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Affiliation(s)
- Sophie G Shay
- Medical College of Wisconsin, 9000 West Wisconsin Avenue, ENT Offices Suite 540, Milwaukee, WI 53226, USA
| | - Taher Valika
- Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 40, Chicago, IL 60611, USA
| | - Robert Chun
- Medical College of Wisconsin, 9000 West Wisconsin Avenue, ENT Offices Suite 540, Milwaukee, WI 53226, USA.
| | - Jeffrey Rastatter
- Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 40, Chicago, IL 60611, USA.
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16
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Albdah A, Alanbari M, Alwadi F. Choanal Atresia Repair in Pediatric Patients: Is the Use of Stents Recommended? Cureus 2019; 11:e4206. [PMID: 31114725 PMCID: PMC6505726 DOI: 10.7759/cureus.4206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Choanal atresia, the obliteration or narrowing of nasal choana, is widely studied across the pediatric and adult population. While unilateral choanal atresia can remain unidentified for several years, bilateral choanal atresia requires immediate intervention, as children are primarily nasal breathers until the initial four months of age. Several surgical methods are reported for repairing choanal atresia in children, and the choice of postoperative management with or without stents is still controversial. In this review, we analyzed several recent studies in which surgery for choanal atresia repair was followed by stent-assisted and/or stentless management. The results of this study are likely to pave the way for a further understanding of the choice of method to increase patency and reduce possible complications.
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Affiliation(s)
| | - Maram Alanbari
- Otolaryngology, General Directorate of Health Affairs in Riyadh Region, Riyadh, SAU
| | - Fahad Alwadi
- Miscellaneous, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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17
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18
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Graham ME, Loveridge KM, Pollard SH, Moore KR, Skirko JR. Infant Midnasal Stenosis: Reliability of Nasal Metrics. AJNR Am J Neuroradiol 2019; 40:562-567. [PMID: 30765383 DOI: 10.3174/ajnr.a5980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/14/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Midnasal stenosis is a poorly defined entity that may be a component of other conditions of nasal obstruction contributing to respiratory distress in infants. We sought to establish whether midnasal vault narrowing is a component of well-defined syndromes of nasal narrowing, such as bilateral choanal atresia and pyriform aperture stenosis, and to characterize the nasal anatomy of patients with syndromic craniosynostosis. MATERIALS AND METHODS A convenience sample of patients with pyriform aperture stenosis, bilateral choanal atresia, and Apert and Crouzon syndromes with maxillofacial CT scans was identified. Patients with Pierre Robin Sequence were used as controls. Nasal measurements were performed at the pyriform aperture, choana, and defined midnasal points on axial and coronal CT scans. Intra- and interrater reliability was quantified with the intraclass correlation coefficient. T tests with Bonferroni adjustment were used to assess differences from controls. RESULTS The study included 50 patients: Eleven had pyriform aperture stenosis, 10 had Apert and Crouzon syndromes, 9 had choanal atresia, and 20 were controls. Measurements in patients with pyriform aperture stenosis and Apert and Crouzon syndromes were narrower than those of controls at all measured points (P < .001). Measurements in patients with choanal atresia were only narrow in the posterior half of the nose (P < .001). The intra- and interrater reliability of midnasal and pyriform measurements was very good to excellent (intraclass correlation coefficient > 0.87). The choanal measurement was good (intraclass correlation coefficient = 0.76-0.77). CONCLUSIONS Pyriform aperture stenosis, Apert and Crouzon patients were narrower at all measured points compared to controls. Bilateral choanal atresia patients were only narrower in the posterior half of the nose. More research is needed to evaluate the clinical implications of these radiographic findings.
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Affiliation(s)
- M E Graham
- From the Department of Otolaryngology-Head and Neck Surgery, and Schulich School of Medicine and Dentistry (M.E.G.), Western University, London, Ontario, Canada.,London Health Sciences Center (M.E.G.), London, Ontario, Canada
| | - K M Loveridge
- Division of Pediatric Otolaryngology-Head and Neck Surgery (K.M.L., S.H.P., J.R.S.), University of Utah and Primary Children's Hospital, Salt Lake City, Utah
| | - S H Pollard
- Division of Pediatric Otolaryngology-Head and Neck Surgery (K.M.L., S.H.P., J.R.S.), University of Utah and Primary Children's Hospital, Salt Lake City, Utah
| | - K R Moore
- Department of Medical Imaging (K.R.M.), Primary Children's Hospital, Salt Lake City, Utah
| | - J R Skirko
- Division of Pediatric Otolaryngology-Head and Neck Surgery (K.M.L., S.H.P., J.R.S.), University of Utah and Primary Children's Hospital, Salt Lake City, Utah
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19
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Abstract
Congenital nasal deformities can cause nasal obstruction with early respiratory distress. Choanal atresia is characterized by no communication between the nasal cavity and nasopharynx. Pyriform aperture stenosis involves more anterior nasal obstruction with limited intranasal space. Nasal masses such as encephaloceles, gliomas, and dermoids are thought to be related through a skull base defect in utero. Imaging with computed tomography and MRI are helpful in distinguishing lesions and identifying intracranial communication. Nasolacrimal duct cysts can get infected and cause obstruction. Nasal septal deviation can be corrected at bedside if detected early. Evaluation and treatment are discussed with all these entities.
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Affiliation(s)
- Roy Rajan
- Department of Surgery, Lehigh Valley Health Network, 1210 South Cedar Crest Boulevard, Suite 1100, Allentown, PA 18103, USA.
| | - David Eric Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 6161B, Baltimore, MD 21287, USA
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20
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Abstract
Choanal atresia is a rare malformation that represents a special challenge. While bilateral choanal atresia usually needs to be surgically treated within a few days of birth, the intervention for one-sided choanal atresia can be postponed for years. Treatment planning requires adequate imaging (CT or MRI), which also serves to exclude other skull base malformities. Surgical treatment currently focuses on transnasal endoscopic techniques. Simultaneous resection of the parts of the vomer involved in the atresia seems to be important surgical success. Postoperative stenting is still controversially discussed. Postoperative application of corticosteroid nasal sprays and saline nasal rinsing for several weeks is of great importance. Due to the rarity of the diagnosis, the absence of prospective randomized controlled trials does not allow definitive statements regarding the optimal surgical technique or stenting.
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