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Gundle L, Ojha S, Hendry J, Rosen H. Stenting versus stentless repair for bilateral choanal atresia: A systematic review of the literature. Int J Pediatr Otorhinolaryngol 2021; 151:110926. [PMID: 34624631 DOI: 10.1016/j.ijporl.2021.110926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/23/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bilateral choanal atresia requires prompt surgical intervention. Surgeons have historically used stents in the repair process, however their efficacy has come into question in recent years. We performed a systematic review to investigate, primarily, whether stents enjoy more favourable outcomes compared to stentless repair. We also explored the use of operative adjuncts, such as steroids, antibiotics, mitomycin C and KTP laser. METHODS We performed a search of the Medline and Embase databases using a search strategy developed with the assistance of an academic librarian. Only full peer reviewed articles were included. Abstracts, posters, case reports and proceedings of academic conferences were excluded. RESULTS We identified 48 unique articles for inclusion, composed of a meta-analysis, two randomised control trials and 45 case series. Pooled analysis of the two randomised control trials yielded no statistically significant difference in choanal patency between stented and stentless repair, but a statistically significant reduction in complications, specifically granulation tissue formation, was found in stentless repair. Data from case series were, overall, of mixed quality, making factors contributing to successful outcomes difficult to elucidate. CONCLUSION Overall, there is a lack of high quality evidence to support the use of either a stented or stentless approach to bilateral choanal atresia repair, however stentless repair may experience fewer complications. Operative techniques, such as the use of mucosal flaps, are worthy of future study. Authors call for future high quality randomised control trials to investigate this uncommon but important condition.
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Affiliation(s)
- Leo Gundle
- University Hospitals Dorset, Poole NHS Foundation Trust, UK.
| | - Shilpa Ojha
- Department of Ear, Nose and Throat Surgery, University Hospitals Bristol NHS Foundation Trust, UK
| | - Joseph Hendry
- Department of Ear, Nose and Throat Surgery, University Hospitals Bristol NHS Foundation Trust, UK
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Lau K, Stavrakas M, Ray J. Lasers in Rhinology-An Update. EAR, NOSE & THROAT JOURNAL 2020; 100:77S-82S. [PMID: 32703032 DOI: 10.1177/0145561320940115] [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] Open
Abstract
OBJECTIVES A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in mind, this article aims to summarize the most recent literature concerning laser application in rhinology. METHODS A literature search from 2000 to 2020 using the PubMed database was employed. Keywords used included "laser," "rhinology," "endonasal endoscopic surgery," "hereditary haemorrhagic telangiectasia," "rhinitis," "refractory rhinitis," "Inferior turbinate hypertrophy," "dacryocystorhinostomy," "septoplasty," "cartilage reshaping" and "choanal atresia." The most up to date studies published for each rhinology condition that could potentially be treated with laser surgery was included. RESULTS Rhinological conditions appropriate for laser applications are discussed. We identified articles related to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies and their limitations. CONCLUSIONS There is currently no one-size-fits-all laser and therefore being up to date on the latest clinical application results can help the clinician decide which are the best treatments to offer their patients.
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Affiliation(s)
- Kimberley Lau
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Marios Stavrakas
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Jaydip Ray
- Otolaryngology Department, 7318Sheffield Teaching Hospitals, Sheffield, United Kingdom
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Moreddu E, Rossi ME, Nicollas R, Triglia JM. Prognostic Factors and Management of Patients with Choanal Atresia. J Pediatr 2019; 204:234-239.e1. [PMID: 30291020 DOI: 10.1016/j.jpeds.2018.08.074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze prognostic factors in the management of patients with choanal atresia. STUDY DESIGN This is a review of 114 patients operated on for choanal atresia in a tertiary care center between November 1986 and November 2016, including clinical characteristics, surgical management, and postoperative course with final nasal patency. The data were collected in a database that was updated over time. RESULTS Among the 114 patients, 78 were female, 77 presented with unilateral choanal atresia, and 37 presented with bilateral unilateral choanal atresia, corresponding to 151 nasal fossae. Forty-seven patients had associated abnormalities (41.2%), including CHARGE, diagnosed in 20 children (17.5%). At the end of follow-up, 91 patients (79.8%) had normal choanal patency. The identified risk factors of surgical failure were age <6 months (P = .004), weight <5 kg (P = .007), and bilateral choanal atresia (P < .001). The type of atresia, presence of associated abnormalities, surgical approach, stenting, and use of mitomycin were not significantly linked with the surgical results. CONCLUSIONS This series highlights the importance of the timing of surgery, which is guided by the clinical ability of the infant to tolerate the procedure. Endoscopic approaches are widely performed, but a transpalatal approach, necessary in some cases of bilateral choanal atresia, does not alter the results. Unilateral choanal atresia surgery should be delayed after age 6 months and/or weight >5 kg when possible.
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Affiliation(s)
- Eric Moreddu
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France.
| | - Marie-Eva Rossi
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Richard Nicollas
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Jean-Michel Triglia
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
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Abstract
PURPOSE OF REVIEW Choanal atresia is a common and widely recognized craniofacial disorder characterized by obliteration of the posterior nasal aperture. Given the long time since its original description, controversy persists regarding pathogenesis and optimal surgical techniques. This review addresses current literature on choanal atresia and identifies areas of debate and future opportunities in research. RECENT FINDINGS Recent molecular mechanisms in retinoic acid receptor development have been described in the pathogenesis of choanal atresia. Whereas surgical treatment is generally believed to be effective in alleviating respiratory symptoms, consistent data confirming efficacy are scarce regarding best surgical approach with and without endoscopic sinus techniques, adjuvant use of stents, use of antiproliferative agents and laser-assisted surgery. Recent studies regarding each technique are discussed. SUMMARY Despite vigorous research, the pathogenesis remains elusive and unproven. Many surgical techniques have been advocated; however, there is no dominant approach. Trends in treatment are directed towards the use of highly advanced endoscopic approaches with the use of microdebriders, small drill bits and telescopes to minimize traumatic injury that leads to postoperative scarring and restenosis.
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Ramsden JD, Campisi P, Forte V. Choanal Atresia and Choanal Stenosis. Otolaryngol Clin North Am 2009; 42:339-52, x. [PMID: 19328897 DOI: 10.1016/j.otc.2009.01.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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D'Eredità R, Lens MB. Contact-diode laser repair of bony choanal atresia: a preliminary report. Int J Pediatr Otorhinolaryngol 2008; 72:625-8. [PMID: 18304657 DOI: 10.1016/j.ijporl.2008.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To demonstrate the use of the contact-diode laser (CDL) at 810 nm wavelength for the transnasal endoscopic repair of bilateral bony choanal (BBCA) in low-weight newborns. METHODS Prospective study at a tertiary-care pediatric institution of four neonates with BBCA aged 3-5 days, weighing on average 2.34 kg. BBCA was opened by transnasal delivery of CDL through a 600 microm diameter glass fiber. Children were stented post-operatively, and revision surgery performed when needed. RESULTS All children were successfully treated for BBCA with CDL. Two children needed only one surgery, one child needed two surgeries, and one patient required three procedures, in order to establish patient choanae at last follow-up ranging from 16 to 30 months. CONCLUSION We found the fiber-delivered contact-diode laser to permit correction of BBCA in four low-birth weight neonates. To the best of our knowledge, this report is the first to demonstrate the successful use of CDL for the management of BBCA.
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Affiliation(s)
- Riccardo D'Eredità
- Pediatric Otolaryngology Division, Department of Otorhinolaryngology--Head and Neck Surgery, Vicenza Civil Hospital, Vicenza, Italy.
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Lapointe A, Giguère CM, Forest VI, Quintal MC. Treatment of bilateral choanal atresia in the premature infant. Int J Pediatr Otorhinolaryngol 2008; 72:715-8. [PMID: 18339432 DOI: 10.1016/j.ijporl.2008.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 01/21/2008] [Accepted: 01/22/2008] [Indexed: 10/22/2022]
Abstract
An innovative technique for choanal atresia repair was used for a unique case of bilateral choanal atresia in a 28-week premature newborn. Endoscopic transnasal KTP laser was employed as an alternative to standard instrumentation to reach the very small atretic plate of a premature nose, providing good visualization of the operative field, thereby avoiding damage to the adjacent structures. The successful repair allowed for early extubation and avoidance of a tracheotomy. The clinical and surgical aspects of the case are discussed. With the likelihood of encountering more premature infants with choanal atresia given the improving neonatal intensive care, we propose that KTP laser repair be considered as an alternative to conventional procedures for this particular population.
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Affiliation(s)
- Annie Lapointe
- Pediatric Otolaryngology, University of Montreal, 3175 Côte-Sainte-Catherine, Montréal, Québec, Canada H3T 1C5.
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Petkovska L, Petkovska I, Ramadan S, Aslam MO. CT evaluation of congenital choanal atresia: our experience and review of the literature. ACTA ACUST UNITED AC 2007; 51:236-9. [PMID: 17504314 DOI: 10.1111/j.1440-1673.2007.01718.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with the nasopharynx. The aim of this study was to investigate and analyse the CT findings in such cases. Seven patients with CCA were included in our study over a 3-year period (2001-2004). All had a CT scan of the nasal cavity and nasopharynx to establish the diagnosis and to define the extent and type of atresia. The choanal atresia was found to be more commonly bilateral and more of the mixed (membranous-osseous) type. Bilateral CCA in the neonate is a medical emergency that should be treated as early as possible. Computed tomography is a valuable and easily accessible diagnostic tool.
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Affiliation(s)
- L Petkovska
- Department of Radiology, Al Adan Hospital, Kuwait.
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Abstract
Although surgical lasers were introduced more than 30 years ago,their use and popularity in nasal and sinus disease have been limited. Even so, there are many practitioners who find the laser a valuable surgical tool for nasal and sinus disease, either alone or in combination with other treatment modalities. Those who do not use lasers probably do not because of a lack of skill, knowledge,or understanding of the role and availability of the technology. This article reviews the history and current role of lasers in nasal and sinus surgery.
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Affiliation(s)
- Howard L Levine
- Cleveland Nasal-Sinus & Sleep Center, 5555 Transportation Blvd., Suite C, Cleveland, OH 44125, USA.
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Sharma RK, Lee CA, Gunasekaran S, Knight LC, Bielby M. Stenting for bilateral congenital choanal atresia--a new technique. Int J Pediatr Otorhinolaryngol 2006; 70:869-74. [PMID: 16293318 DOI: 10.1016/j.ijporl.2005.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2005] [Revised: 09/25/2005] [Accepted: 09/26/2005] [Indexed: 11/18/2022]
Abstract
We describe a new nasal stent for the treatment of bilateral congenital choanal atresia. The stent is made up of reinforced endotracheal tube mounted on a portex carrier tube. It potentially causes less internal crusting and stent blockage and is secured without sutures. It remains patent for at least 4 weeks. We have used the stent successfully in six patients between 1998 and 2004 at Leeds General Infirmary and present the data collected retrospectively. The current practice in the UK for treatment and stenting for congenital choanal atresia was investigated by a prospective internet based questionnaire sent to 18 consultant paediatric otolaryngologists of whom 12 (67%) responded. Their experience and results are reported. The literature has been reviewed.
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Affiliation(s)
- R K Sharma
- Leeds General Infirmary, Department of Otolaryngology, 64, Daisy Hall Drive, Westhoughton, Bolton BL5 2SB, UK.
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Kubba H, Bennett A, Bailey CM. An update on choanal atresia surgery at Great Ormond Street Hospital for Children: preliminary results with Mitomycin C and the KTP laser. Int J Pediatr Otorhinolaryngol 2004; 68:939-45. [PMID: 15183586 DOI: 10.1016/j.ijporl.2004.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2003] [Revised: 02/18/2004] [Accepted: 02/24/2004] [Indexed: 11/15/2022]
Abstract
We present the results of transnasal choanal atresia correction in 46 children, as an update to the published Great Ormond Street Hospital series. Females outnumbered males 2-1, and half the cases in our series were bilateral. Eight of the children with bilateral atresia had the CHARGE association. The median number of procedures required was three over a period of up to 3 years. Eighty-two percent of children with unilateral atresia and 78% of those with bilateral atresia were asymptomatic at the time of their last follow up. Four deaths occurred, all but one in children with CHARGE association. We were not able to demonstrate any benefit from the use of Mitomycin C, the KTP laser, betamethasone nasal drops or (in unilateral cases) stents.
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Affiliation(s)
- Haytham Kubba
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
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Kitai N, Iguchi Y, Takashima M, Murakami S, Kreiborg S, Kamiji T, Takada K. Craniofacial morphology in an unusual case with nasal aplasia studied by roentgencephalometry and three-dimensional CT scanning. Cleft Palate Craniofac J 2004; 41:208-13. [PMID: 14989680 DOI: 10.1597/02-112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine the three-dimensional morphology of internal structures of the craniofacial region and present the orthodontic problems in an unusual case with nasal aplasia. PATIENT The patient was an 11.5-year-old boy with aplasia of the nose and nasal cavity with extremely constricted nasopharyngeal airway. He did not have mental or somatic retardation. The patient had dacryostenosis. The morphology of the craniofacial structures was characterized by absence of septal structures, including cribriform plate, perpendicular plate of ethmoid bone, vomer, and septal cartilage; bony hypotelorism; midface hypoplasia; short and retrognathic maxilla with Class III jaw relationship; average mandibular plane angle; high arched palate; severe anterior open bite with bilateral posterior crossbites; and dental anomalies (agenesis of four maxillary permanent teeth, microdontia, taurodontism, and short roots). Thus, the patient had characteristic dentofacial phenotype, which might be caused by a combination of the primary anomaly and the functional disturbances secondary to the nasal obstruction.
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Affiliation(s)
- Noriyuki Kitai
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University, Osaka, Japan.
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Hopf JU, Hopf M, Scheller EE, Scherer H. Endoscopic Laser Surgery of Choanal Atresia – The New Retropalatine Approach. ACTA ACUST UNITED AC 2002. [DOI: 10.1078/1615-1615-00067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Morimoto N, Kawashiro N, Tsuchihashi N, Shishiyama F. Congenital Choanal Atresia and Nasal Stenosis. ACTA ACUST UNITED AC 2002. [DOI: 10.3950/jibiinkoka.105.5_570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Noriko Morimoto
- Department of Otolaryngology, National Center for Child Health and Development
| | - Nobuko Kawashiro
- Department of Otolaryngology, National Center for Child Health and Development
| | - Nobuaki Tsuchihashi
- Department of Otolaryngology, National Center for Child Health and Development
| | - Fumiko Shishiyama
- Department of Otolaryngology, National Center for Child Health and Development
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