choanal atresi

1. CHOANAL ATRESIA
BY
ULFAT AMIN
MSC PEDIATRIC NURSING
2016-2018

2. INTRODUCTION
• Choanal atresia is a congenital disorder where the
back of the nasal passage (Choana) is blocked,
usually by abnormal bony or soft tissue
(membranous) due to failed recanalization of the
nasal fossae during fetal development. The word
“Choana” comes from the Greek word meaning
“funnel”. The choana is essentially the posterior
nasal aperture by which air flows from the nasal
cavity into the nasopharynx.

3. • Choanal atresia is a rare condition that affects
babies .it is caused by a blockage of choana,
which is a passage way that connects each side
of nose to the throat. These passageways are
essential for breathing through the nose. It is
a congenital condition, the condition may be
present as an isolated birth defect in a baby
that is otherwise healthy or it could be a part
of genetic disorder called charge syndrome
that affect various organs.

4. HISTORY AND
EPIDEMIOLOGY
• Choanal atresia was first described by a physician named
Roederer in 1755. However, the first recorded surgical repair
was done in 1854.
• The condition is the most common nasal abnormality in
newborn infants, affecting about 1 in 7,000 live births. Females
get this condition about twice as often as males. More than
half of affected infants also have other congenital problems.
In general, unilateral choanal atresia is more common than
bilateral (65-75% of patients with unilateral)

5. Types of choanal atresia:
• UNILATERAL CHOANAL ATRESIA: this is
more common of the two & is also a less
threatening, atresia effects just one side of the
nasal passageways.

6. • BILATERAL CHOANAL ATRESIA: this can be a life
threatening as blockage affects both passageways,
causing extreme respiratory difficulty. In some cases this
may present with cyanosis while the baby is feeding,
because the oral air passages are blocked by tongue,
further restricting the airway. The cyanosis may improve
when the baby cries, as oral airway is used at this time.

7. Causes
• The cause of choanal atresia is unknown. By the 38th day
of development, the 2-layer membrane consisting of nasal
and oral epithelia ruptures and forms the choanae
(posterior nares). Failure of this rupture results in choanal
atresia. In 2008, Barbero et al suggested that prenatal use
of antithyroid (methimazole, carbimazole) medications was
linked to choanal atresia

8. Signs/Symptoms
• Bilateral Atresia: Presents as a newborn, Cyanosis, Increased
respiratory effort, Chest retractions, Classically
cyanosis/saturations improve with crying, Inability to nurse and
breathe at same time.
• Unilateral: Present later in life (non-emergent), Chronic nasal
discharge, Nasal obstruction, Thick nasal secretions on
examination

9. Diagnosis
• A physical exam may show an obstruction of the nose.
Inability to pass NG tube – 6 Fr.

10. Look for charge syndrome
•
• Coloboma( Essentially a hole in one of the structures of
the eye . Affects iris, retina (most common)
• Heart defects(Also PDA, ASD, and VSD)
• Atresia of the Choana
• Retardation of Growth
• Genitourinary hypoplasia
• Ear anomalies

11. • Tests that may be done include:
• CT scan
• Endoscopy of the nose
• Sinus x-ray

12. Treatment
• The immediate concern is to resuscitate the baby
if necessary.
• An airway may need to be placed so that the
infant can breathe. In some cases, intubation or
tracheostomy may be needed.

13. • Surgery to remove the obstruction cures the problem.
Surgery may be delayed if the infant can tolerate mouth
breathing. The surgery may be done through the nose
(transnasal) or through the mouth (transpalatal). Most
bilateral can be done within the first few days of life to
aid in growth and development . In either case,
endoscopic or open, a temporary stent may or may not
be placed to keep the newly created choana open.
• If the blockage is caused by bone, this is drilled
through and stent is inserted.

14. • Outlook (Prognosis)
• Full recovery is expected.
• Complications:
• Possible complications include:
• Aspiration while feeding and attempting to
breathe through the mouth
• Respiratory arrest
• Re narrowing of the area after surgery

15. NURSING MANAGEMENT
• Nurse should Consider CA in newborn/child with
symptoms of nasal obstruction, so proper physical
examination should be done.
• There is high association of choanal atresia with other
congenital defects, nurse must look for other defects
also.

16. • The most crucial initial interventions in a child with
bilateral atresia should focus on stabilizing the patient.
In achieving this, the goal should be finding a way to
oxygenate the patient despite the crippling upper
airway obstruction. For this purpose one may use a
special nipple called a McGovern nipple which has a
large hole in its center for air passage or a plastic oral
airway piece.
• Tracheostomy care must be provided to the child with
tracheostomy.

17. • Input output should be maintained before and
after surgery
• Keep the client warm.
• An intravenous drip is used to hydrate the
patient.
• Monitor patients vital signs

18. • Provide oxygen in case of dyspnea and cyanosis
• All drugs to be administered keeping in mind
five steps of drug administration
• Suction the nasal stents so that they don’t get
blocked up

19. • Teach parents also how to suction to keep stent patent for
period of three months after surgery till stent will be removed
• Nurse must teach how to keep nose clean & how to give your
baby nose drops
• Make sure clients nasal passage is patent before starting feed.

20. THANKYOU