Endonasal repair of choanal atresia, does stenting have a better outcome ?

الملخص EN

Background: A prospective study designed to compare the short term and long term operative outcomes of transnasal endoscopic repair of congenital choanal atresia (CCA) with and without postoperative stenting.

Methods: Twelve cases from 2008 to the beginning of 2010 with either unilateral or bilateral choanal atresia of neonates have been endoscopically repaired, stents were used in seven cases where the other five cases did not have any stenting.

Careful follow-up for about 9 months with postoperative CT was done for every case.

Results: Twelve patients were treated for CCA––between 2008 and 2010––7 patients (4 females and 3 males) (5 unilateral and 2 bilateral) (age range 4 days–17 years) were put in the first group, where stents were used, while the other group comprised five patients (3 females and 2 males) (4 unilateral and 1 bilateral) (age range 2 days–2 years) where no postoperative stents were used).

Patent choanae resulted in 4 patients only (57%), with three patients (43%) in the first group needed revision (diagnosed on routine endoscopic follow-up after stent removal), while only on case (20%) in the second group, needed revision (granulations and synechiae almost occlude the new choana).

Severe signs of inflammation and irritation were noted in the three stented failed cases (2 bilateral and one unilateral cases) at the columela and anterior nares in addition to dysphagia reported by parents.

Conclusion: The transnasal endoscopic technique is the approach of choice for repair of CCA because of good visualization of the posterior choana and the ability to open the defect with a high surgical success rate.

Stenting seems not to have a better postoperative outcome or even may have a worse prognosis––in our series––on decreasing the incidence of occurrence of postoperative granulations and restenosis, in addition to the occurrence of local inflammatory reaction and dysphagia.

Duration of postoperative stenting is still a matter of debate, specially in neonates, and needs further research work.