Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis

Abstract Introduction: Choanal atresia is a rare congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae. In 67% of cases choanal atresia is unilateral, affecting mainly (71%) the right nasal cavity. In contrast to the unilateral form, bilateral choanal atresia is a life-threatening condition often associated with respiratory distress with feeding and intermittent cyanosis exacerbated by crying. Surgical treatment remains the only therapeutic option. Objective: To report our experience in the use of a transnasal endoscopic approach with stentless single side-hinged flap technique for the surgical management of choanal atresia. Methods: A 5 year retrospective analysis of surgical outcomes of 18 patients treated for choanal atresia with a transnasal technique employing a single side-hinged flap without stent placement. All subjects were assessed preoperatively with a nasal endoscopy and a Maxillofacial computed tomography scan. Results: Ten males and eight females with a mean age at the time of surgery of 20.05 ± 11.32 years, underwent surgery for choanal atresia. Fifteen subjects (83.33%) had a bony while 3 (26.77%) a mixed bony-membranous atretic plate. Two and sixteen cases suffered from bilateral and unilateral choanal atresia respectively. No intra- and/or early postoperative complications were observed. Between 2 and 3 months after surgery two cases (11.11%) of partial restenosis were found. Only one of these presented a relapse of the nasal obstruction and was subsequently successfully repaired with a second endoscopic procedure. Conclusion: The surgical technique described follows the basic requirements of corrective surgery and allows good visualization, evaluation and treatment of the atretic plate and the posterior third of the septum, in order to create the new choanal opening. We believe that the use of a stent is not necessary, as recommended in case of other surgical techniques involving the use of more mucosal flaps.

摘要：后鼻孔闭锁（choanal atresia）是一种罕见的鼻腔先天性畸形，特征为后鼻孔完全闭塞。67%的病例为单侧后鼻孔闭锁，其中71%累及右侧鼻腔。与单侧病变不同，双侧后鼻孔闭锁为危及生命的病症，常伴随喂养时呼吸困难、间歇性发绀，且哭闹时症状会进一步加重。外科手术仍是此类病症唯一的治疗手段。

研究目的：本研究旨在报告采用无支架单侧蒂瓣经鼻内镜术式治疗后鼻孔闭锁的临床经验。

研究方法：对18例采用无支架单侧蒂瓣经鼻技术治疗后鼻孔闭锁的患者开展了为期5年的手术结局回顾性分析。所有受试者术前均接受鼻腔内镜检查及颌面计算机断层扫描（computed tomography, CT）。

研究结果：本研究共纳入18例接受后鼻孔闭锁手术的患者，其中男性10例、女性8例，手术时平均年龄为20.05±11.32岁。15例（83.33%）患者存在骨性闭锁板，3例（26.77%）为骨-膜混合性闭锁板。双侧及单侧后鼻孔闭锁病例分别为2例与16例。未观察到术中及/或早期术后并发症。术后2至3个月时，共发现2例（11.11%）患者出现部分再狭窄；其中仅1例出现鼻塞复发，随后通过第二次内镜手术成功修复。

研究结论：本研究所描述的手术术式符合矫正手术的基本要求，可实现对闭锁板及鼻中隔后1/3区域的良好可视化、评估与处理，从而重建新的后鼻孔通道。我们认为，相较于其他需使用更多黏膜瓣的手术技术，本研究无需使用支架，这一观点与相关推荐相符。