Presentation
Respiratory distress, more pronounced during feeding, inability to pass NG tube
Patient Data
Axial and coronal facial and PNS CT with bone window settings show narrowing of the anterior nasal opening. The choanae are patent bilaterally. No central megaincisor. Oropharyngeal airway is in place.
The nasal pyriform aperture (solid arrow) measures 5.5 mm in width. Bilateral posterior nasal openings (choanae, arrowheads) are patent.
Case Discussion
Congenital nasal pyriform aperture stenosis is a rare cause of nasal obstruction in neonates. It has a similar clinical presentation to choanal atresia (respiratory distress, cyanosis in the newborn that is exacerbated with feeding and improves with crying). It can be associated with other anomalies such as a central megaincisor and holoprosencephaly. Its diagnosis is confirmed with CT, the diagnostic finding being a pyriform aperture that measures less than 11 mm in width in a term infant.
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