Choanal atresia

Last revised by Mostafa Elfeky on 3 Jan 2024

Choanal atresia refers to a lack of formation of the choanae, the openings providing communication between the nasal cavity and nasopharynx. It can be unilateral or bilateral.

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

Syndromic associations include

Other associations include

Presentation depends on whether it is uni- or bilateral. Unilateral choanal atresia presents late and can be asymptomatic or present with rhinorrhea. Bilateral atresia can present with neonatal respiratory distress as infants are obligate nasal breathers. Another finding is failure to pass a nasogastric tube beyond 32 mm.

Approximately two-thirds of cases are unilateral 6,7.

Structurally there are two main types:

  • osseous: ~90% 2

  • membranous: ~10%

General pathogenesis includes:

Assessment with axial CT may show:

  • a uni- or bilateral posterior nasal narrowing with an obstruction

  • airway less than 3 mm

    • measurement is done at the reference level of the pterygoid plates in the axial plane

  • an air-fluid level above the obstruction point

  • thickening of the vomer

  • medial bowing of posterior maxillary sinus

Options include:

  • endoscopic perforation (for membranous types)

  • full choanal reconstruction

On axial CT consider:

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