CHOANAL ATRESIA

Historical Background

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

• .

DEFINITION

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

• Rare congenital anomily

• 1 in 5000 to 8000 live births

• Female male ratio is 2:1

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.

• Chromosomal anomalies are found in 6% of infants with choanal atresia.

• • Choanal atresia occurs with equal

frequency in people of all races

ASSOCIATIONS

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

EMBRYOGENESIS

• Theory 1• Hochstaller or buccopharyngeal

membrane from foregut

• Rupture of membrane 5 -6 week of gestation

• Forms choanae

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

Etiology

• 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.

TYPES

UNILATERAL

BILATERAL

TYPE 2

• BONY MIXED

TYPES

• CONGENITAL

• ACQUIRED

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

UNILATERAL

• Rarely causes respiratory distress• Mucoid discharge

• OTHER MANIFESTATIONS• Feeding difficulty• Respiratory collapse• Failure to thrive

DIAGNOSIS

• Physical examination• Passing of a feeding tube through nose

• Observing misting on a metal spatula or laryngeal mirror

• Placing methylene blue in nasal cavity

• Endoscopic examination

RADIOGRAPHY

Acoustic rhinometry

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

Computed tomography

Diagnosis Confirmation• Confirmed with CT

with intranasal contrast that shows narrowing of the posterior nasal cavity

MANAGEMENT

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

Mc Govern nipple

Oropharyngeal airway

ENDOTRACHEAL INTUBATION

TRACHEOSTOMY

UNILATERAL

SURGICAL REPAIR

• TRANSNASAL APPROACH

• TRANSPALATAL APPROACH

TRANSNASAL APPROACH

TRANSPALATAL APPROACH-

STENT PLACEMENT

ENDOSCOPIC CHOANOPLASTY WITHOUT

STENT PLACEMENT

COMPLICATIONS

• INFECTIONS• BLEEDING• GROWTH PROBLEMS• SCARRING• RESTENOSIS

NURSING MANAGEMENT

• Assessment• Diagnosis• Planning• Intervention• Evaluation