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Choanal atresia (say "KOH-uh-nul uh-TREE-zhuh") is blockage by
bone or tissue of the nasal passages (choana) leading from the back of the nose
to the throat. The condition—present at birth in about 1 out of 7,000 babies—makes
it impossible to breathe through the nose. Choanal atresia is diagnosed at
birth when both passages are blocked. If only one passage is blocked, the
diagnosis may be made later, usually after you notice that mucus drains from
only one of your baby's nostrils.
Repair involves surgery to reopen the nasal passages. Your baby
may have a
computed tomography (CT) scan, a form of X-ray, before
the repair to help the doctor confirm the diagnosis and plan the
Your baby will receive
general anesthesia for the operation. The surgeon can
choose one of two approaches: inserting instruments through the nostrils
(transnasal) or making an incision in the roof of the mouth (transpalatal). The
doctor chooses the approach based on several things, including the anatomy of
the nasal passages. The surgeon may prefer to operate through the nose if
thin tissue blocks the nasal passages. He or she may prefer to do the surgery through the roof of the mouth if
thick bone blocks the nasal passages.
In both approaches, the doctor stitches tubes called nasal stents
into the passages to keep them open. After 6 or more weeks, the doctor removes
After surgery, your baby should be able to breathe normally and
will be able to breast-feed or bottle-feed. Newborns stay in the hospital for a
few days. Older children who have surgery on one side may go home after a day or
two. Health professionals will teach you how to suction your baby's nasal
passages at home to keep the stents open until they can be removed. They also
will have you watch for complications (such as infection or bleeding) and will
tell you when to call if a problem develops.
After the stents are removed, the doctor may use a thin, lighted
instrument (endoscope) to look into the nose to make sure the
airways are open.
The surgery opens nasal passages to allow the baby to breathe. A
newborn can only breathe through the nose (except when crying) in the first
weeks of life.
Surgery cures the problem. Most children need only one operation. But in some cases, the procedure may be repeated if the nasal passages close
The main risk of surgery to repair choanal atresia is needing
another surgery if the airway does not stay open.
In general, children have a small risk of infection or bleeding.
Any surgery involving general anesthesia carries a small amount of risk. Call
the doctor if your child has bleeding, a fever of
100.5°F (38.1°C), pus coming
from the nose, or you are unable to keep the stents clear so your child can
Injury to the nasal passages and skull may
occur during surgery. But this is rare.
Surgery may be delayed until the child is 2 or 3 years old if only
one nasal passage is blocked.
The transnasal method requires less operating time than the
transpalatal approach. But the risk of the nasal passages closing again may be
higher with the transnasal approach.
Other Works Consulted
Suurna MV (2012). Noncongenital anomalies of the nose. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 258–264. New York: McGraw-Hill.
October 14, 2013
Adam Husney, MD - Family Medicine & Donald R. Mintz, MD - Otolaryngology
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