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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.
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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
General pathogenesis includes:
teratogenic effects caused by early pregnancy use of antithyroid drugs 8
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
Treatment and prognosis
endoscopic perforation (for membranous types)
full choanal reconstruction
On axial CT consider:
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- 6. Hengerer AS, Brickman TM, Jeyakumar A. Choanal atresia: embryologic analysis and evolution of treatment, a 30-year experience. Laryngoscope. 2008;118 (5): 862-6. doi:10.1097/MLG.0b013e3181639b91 - Pubmed citation
- 7. Szeremeta W, Parikh TD, Widelitz JS. Congenital nasal malformations. Otolaryngol. Clin. North Am. 2007;40 (1): 97-112, vi-vii. doi:10.1016/j.otc.2006.10.008 - Pubmed citation
- 8. Andersen SL, Olsen J, Wu CS et-al. Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study. J. Clin. Endocrinol. Metab. 2013;98 (11): 4373-81. doi:10.1210/jc.2013-2831 - Pubmed citation