Evaluation and Advantage of Posteriorly Sited Curved Stent Tube in Congenital Bilateral Choanal Atresia

Abstract

Background: Choanal atresia is a congenital disorder in which the posterior nares are close by unresolved membrane or bony partition. This disease is treated surgically.

Aims of the study: To evaluate the outcome and complications of different methods of stenting in bilateral congenital choanal atresia and to identify the most suitable method in our practice.

Methods: A prospective study carried out at Departments of Otolaryngology. Sixteen neonates with congenital bilateral choanal atresia underwent operation via convention transnasal approach with stenting. The neonates were submitting to full history taking, examination, investigations including imaging in form of computed tomography (CT) scan of nose and paranasal sinuses. Portex endotracheal tubes were fashioned preoperatively, then use for stenting the posterior choanae after removing the obstructing element for 12 weeks. Patients were arranging into two groups: group A (10 patients) with the curved part of the stent tube was sited posterior to the choanae and, group B (6 patients) curved part of the stent tube was sited anterior to columella. Complications of stenting are compared, including stent dislodgement, early extraction, erosion of nares, obstruction, granulation and nose bleeding were assessed, and the outcomes are evaluated for the two groups.

Results: Sixteen neonates (11 female and 5 male). Their age was between 2 and 7 days. After removal of the stent tubes, the outcome and complication of stent for the two groups are compared after follow up (mean duration of follow up 6.5 months). Choanae assessed by endoscopic examination in outpatient, one of (group A) needed a second operation while five patients in (group B) needed it. Two patients from group B need a third operation while none of (group A) are needed. The patients had patent posterior choanae at last follow up.

Conclusion: Stenting after correction of congenital bilateral choanal atresia is desirable to prevent restenosis. The stability of stenting better obtained by using posteriorly placed curve of a single portex tube as stent (arch), (group A). While the stability of stenting by two separate tubes or anteriorly placed curved end is unobtainable because of the cheese wire effect of securing silk suture on the posterior end of septum (group B). Several complications were significantly less frequent with posteriorly placed curve of single portex tube stent method. Therefore, it is recommended applying posteriorly placed curve of a single portex tube method in practice.