CHOANAL ATRESIA IN CHILDREN

1. CHOANAL
ATRESIA

2. Historical Background
• In 1755, Roederer first described congenital
choanal atresia; therefore, this condition
has been recognized for more than 200
years.
• .

3. DEFINITION
Developmental failure of the nasal cavity to
communicate with the nasopharynx.

4. • Rare congenital anomily
• 1 in 5000 to 8000 live births
• Female male ratio is 2:1

5. Epidemiology
• Occurs in ~1 in 5,000 – 7,000 live births
• More common in girls than boys
• Slightly increased risk exists in twins.
• Maternal age or parity does not increase the
frequency of occurrence.

6. • Chromosomal anomalies are found in 6%
of infants with choanal atresia.
•
• Choanal atresia occurs with equal
frequency in people of all races

7. ASSOCIATIONS
CHARGE ASSOCIATION
• Coloboma
• Heart disease
• Atresia of choanae
• Retarded G and D
• Genital hypoplasia
• Ear deformities or deafness

8. EMBRYOGENESIS
• Theory 1
• Hochstaller or buccopharyngeal
membrane from foregut
• Rupture of membrane 5 -6 week of
gestation
• Forms choanae

9. •
•
•
•
Theory 2
Abnormal persistence of mesoderm
Adhesions of the region
Atesia

10. Etiology
• By the 38th day of development, the 2-layer
membrane consisting of nasal and oral epithelia
ruptures and forms the choanae (posterior nares).

11. • 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.

13. TYPES
UNILATERAL
BILATERAL

14. TYPE 2
• BONY
MIXED

15. TYPES
• CONGENITAL
• ACQUIRED

16. Clinical manifestations
BILATERAL
• Complete nasal obstruction
• Immediate respiratory distress
• Potential death due to asphyxia
• Cyclic respiratory obstruction
• Child cries opens the mouth
• obstruction is relieved

17. UNILATERAL
• Rarely causes respiratory distress
• Mucoid discharge
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OTHER MANIFESTATIONS
Feeding difficulty
Respiratory collapse
Failure to thrive

18. DIAGNOSIS
• Physical examination
• Passing of a feeding tube through nose

20. • Observing misting on a metal spatula or
laryngeal mirror
• Placing methylene blue in nasal cavity
• Endoscopic examination

21. RADIOGRAPHY

22. Acoustic rhinometry
• new technique which evaluates nasal
obstruction by analysing reflections of a
sound pulse introduced via the nostrils.

23. Computed tomography

24. Diagnosis Confirmation
• Confirmed with
CT with intranasal
contrast that
shows narrowing
of the posterior
nasal cavity

25. MANAGEMENT
•
•
•
•
IMMEDIATE MANAGEMENT
Breathe through mouth
Mc govern nipple
Oropharyngeal airway

26. Mc Govern nipple

27. Oropharyngeal airway

28. ENDOTRACHEAL
INTUBATION

29. TRACHEOSTOMY

30. UNILATERAL

31. SURGICAL REPAIR
• TRANSNASAL APPROACH
• TRANSPALATAL APPROACH

32. TRANSNASAL APPROACH

33. TRANSPALATAL APPROACH-

34. STENT PLACEMENT

35. ENDOSCOPIC
CHOANOPLASTY WITHOUT
STENT PLACEMENT

36. COMPLICATIONS
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•
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INFECTIONS
BLEEDING
GROWTH PROBLEMS
SCARRING
RESTENOSIS

37. NURSING MANAGEMENT
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Assessment
Diagnosis
Planning
Intervention
Evaluation