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Choanal atresia

Dr Maxime St-Amant and Dr Yuranga Weerakkody et al.

A choanal atresia refers to a lack of formation of the choanal openings. It can be unilateral or bilateral.

Epidemiology

It frequently presents in neonates where it is one of the commonest causes of nasal obstruction in this age group. There is a recognised female predilection. The incidence is estimated at ~ 1 : 5000 - 8000.

Clinical presentation

Depends on whether it is uni or bilateral. Unilateral choanal atresias present late and can be asymptomatic or present with rhinorrhoea while bilateral atresias can present with neonatal respiratory distress (infants are obligate nose breathers). Another finding is failure to pass a nasogastric tube.

Approximately two third of cases are unilateral ^6-7.

Pathology

Structurally there are two main types

osseous : ~ 90 % ²
membraneous : ~ 10 %

Associations

Syndromic associations include

Other associations include

Radiographic features

CT

Axial CT scans are best as assessment

may a show a uni or bilateral posterior nasal narrowing with an obstruction
airway less than 0.3 cm
an air fluid level may be present above the obstruction point
may show thickening of the vomer
medial bowing of posterior maxillary sinus

Treatment

Options include

endoscopic perforation (for membranous types)
full choanal reconstruction

Differential diagnosis

On an axial CT consider

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