Congenital bilateral adult choanal atresia undiagnosed until the second decade: How we did it

Bilateral Choanal Atresia in 24 Years Old Woman: A Case Report

Background

Choanal atresia is a congenital anomaly characterized by an absence of the nasal choanae due to Failure to recanalize the nasal fossae during embryogenesis. Instances involving unilateral Choanal atresia may go unidentified for extended periods. Bilateral choanal atresia presenting in adulthood is an infrequent occurrence.

Case Presentation

A case of bilateral choanal atresia in a female 24-year-old presenting to our otolaryngology department's out clinics with long-standing nasal obstruction, mouth breathing, and anosmia. She underwent endoscopic choanoplasty to reestablish patency of the posterior choana. Follow-up after one month revealed patent posterior choana.

Conclusion

Bilateral choanal atresia requires early surgical intervention in infants for survival. Adult presentations are rare. Nasal endoscopy and CT help determine the surgical approach. Endoscopic trans-nasal Chonaolplasty is typically the standard treatment.

Empirical overview of a delayed diagnosis of bilateral congenital choanal atresia in an adolescent male: management with 'coblation-assisted surgery'

Bilateral choanal atresia (CA) is a congenital anomaly consisting of an imperforated choana that leads to newborn fatalities but, if unilateral, may go unnoticed for many years. Bilateral CA occurring without significant symptoms and remaining undiagnosed for many years is rare. This case report identifies an adolescent male with bilateral CA who remained undiagnosed till adolescence. The patient presented with isolated complaints of chronic nasal obstruction and discharge and was diagnosed with bilateral CA by endoscopic and radiological evaluation. The patient underwent a coblation-assisted endoscopic CA repair, with a crossover mucoperiosteal flap technique, without stenting and with a successful outcome.

Bilateral Choanal Atresia in an Adolescent Female: A Rare Case Report

Choanal atresia is a rare congenital anomaly of the nasal cavities characterized by lack of patency of the posterior ends of one or both nasal cavities (choanae). It is the most common congenital anomaly of the nasal cavity. Bilateral choanal atresia accounts for a third of the cases and is almost invariably detected in the neonatal age due to respiratory distress. Detection of bilateral choanal atresia in adulthood is extremely rare and has been reported only a few times. We report a case of a teenage girl who was diagnosed with bilateral choanal atresia after presenting with longstanding snoring and intermittent nasal discharge. She was managed with bilateral transnasal endoscopic choanoplasty to restore the choanal patency.

Transnasal endoscopic neochoanal technique: An effective procedure for bilateral choanal atresia in adult female

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.

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Choanal atresia in adults is often related to the socioeconomic status of the patient.

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The transnasal endoscopic neochoanal technique is an effective procedure for choanal atresia.

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Low socioeconomic status may cause a delay in diagnosis and thus management of choanal atresia.

Bilateral choanal atresia in a 60-year-old man: A case report and review of the literature

Choanal atresia is a congenital condition referring to the blockage of the posterior nasal cavity. As bilateral choanal atresia (BCA) causes complete nasal congestion, it usually results in death due to asphyxia in the newborn if no emergency intervention is performed. Therefore, it is very rare to see a patient with BCA who has reached an advanced age. There are only 11 adult cases reported in the recent literature. Here, we report a case of a 60-year-old man diagnosed with BCA and we discuss the clinical presentation and treatment modalities with a review of the literature.

Anesthesia management in patients with choanal atresia

In this retrospective study, we reviewed the anesthesia management of patients with choanal atresia (CA). Fourteen patients undergoing surgery for CA between June 2007 and September 2018 were evaluated for age, gender, CA side, complications, American Society of Anesthesiologists score, duration of anesthesia, and presence of any additional anomalies. Six patients (42%) had bilateral atresia, and 8 (58%) had unilateral atresia. Various congenital anomalies were present in 50% of patients with bilateral atresia. Three patients were intubated with a C-MAC D pediatric blade because their Cormack-Lehane grade was 3 or 4. Though sevoflurane was used for all patients, total intravenous anesthesia was used for two patients with unilateral atresia. All patients were followed postoperatively while intubated except one patient with bilateral atresia. There was no need for postoperative intubation of any patients with unilateral atresia. In conclusion, clinicians should be aware of perioperative and postoperative complications in patients with CA, bilateral atresia, and accompanying congenital anomalies in the neonatal period. Total intravenous anesthesia can be chosen instead of inhalation anesthesia in appropriate cases, but sevoflurane can be used safely in the induction of anesthesia.

Stentless endoscopic repair of congenital choanal atresia: is it enough for maintaining choanal patency?

The aim of choanal atresia (CA) surgery is to achieve bilateral nasal patency. Among the different methods of CA repair, the endoscopic transnasal approach has gained recent popularity with the advent of endoscopic instruments and techniques. This article describes our experience regarding CA repair that was done either using or not using a stent in different periods of time in our department. Between February 2006 and February 2016, a total of 29 patients aged 2 days-53 years underwent endoscopic transnasal CA repair. While in early years stents were used to maintain nasal patency, since 2010, all cases were repaired endoscopically without stenting. Of the 29 patients, 8 were excluded because of inadequate follow-up data. The mean follow-up time for the remaining 21 patients after surgery averaged 53 months (range 12-111 months). Intranasal stents were used in 5 of 21 patients for 8 out of 32 operative sides. Of the 8 stented neochoanae, 6 (75%), restenosed at a mean time of 15.2 weeks (5-24). The restenosis rate was 25% (6/24 nasal sides) in 16 patients who underwent stentless repair. In unilateral CA, 2 of 10 (20%) patients underwent atresia repair using stents and only these cases restenosed after surgery in this group. Of the 11 patients with bilateral disease, 5 (45.4%) underwent revision surgeries. In the bilateral group, 2 of 3 (66.6%) stented patients required revision surgeries, whereas 3 of 8 (37.5%) patients who underwent stentless repair relapsed. In one patient, we have experienced an alar cartilage injury intraoperatively caused by drilling. The transnasal endoscopic repair has proved to be effective and yielded long-term satisfactory results. The use of stent seems to have no advantage over a stentless repair regarding maintenance of a patent nasal airway. Patients experienced restenosis more frequently with stenting.

A rare case report of bilateral choanal atresia in an adult

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Choanal atresia is a congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae.

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Adult bilateral choanal atresia is a rare entity.

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Endoscopic transnasal choanoplasty is the criterion standard treatment.

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The exact role of the postoperative stent and use of mitomycin C is controversial.

Introduction

Adult choanal atresia is a rare congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae, only ninth cases are reported in the literature, we present in our observation the tenth case of adult bilateral choanal atresia.

Presentation of case

A 18-year-old man presented at our department with complaints of nasal obstruction, nasal discharge, snoring, anosmia, and mouth breathing since childhood. Endoscopic examination and paranasal sinus tomography revealed bilateral choanal atresia. An endoscopic choanoplasty was performed. Follow-up evaluation at postoperative 12th month showed that his symptoms improved significantly and, on endoscopic examination, both choanae remained patent.

Discussion and conclusion

Adult bilateral choanal atresia is a rare entity. The revelation in adulthood of congenital bilateral atresia remains exceptional. Nasal endoscopy and preoperative computed tomography scan help in planning surgery. Endoscopic transnasal choanoplasty is the criterion standard treatment. The exact role of the postoperative stent and use of mitomycin C is controversial.