Management of bilateral choanal atresia in the neonate: an institutional review.

The endoscopic repair of bilateral choanal atresia using powered instrumentation has become a common procedure performed by many pediatric otolaryngologists. A 10-year retrospective review of the management of bilateral choanal atresia in the neonate was undertaken at the Hospital for Sick Children, a tertiary care pediatric institution in Toronto. Although many techniques were used for repair including the endoscopic technique, a simple puncture, dilation and stenting technique was used most frequently. Fifty-two patients were identified who underwent this technique. The modifications and refinements of this technique and post-operative care will be detailed. The results were as follows. All patients were successfully extubated within 24h of the operation. The average duration of nasal stenting was 3 months. Three patients required re-stenting, one of which had nasal stenting for the first year of life. This patient was born prematurely, had trisomy-21 and was stented weighing a mere 600g. One patient had a small septal perforation and only two patients required transpalatal repair later in life for persistent nasal symptoms. There were no CNS complications and no incidence of significant nasal hemorrhage or infection. All patients received topical antibiotics and steroid drops during the stenting period. Mitomycin C was not used. Granulation tissue was not a significant problem. Despite the advances in endoscopic technology, the puncture, dilation and stenting technique is still the senior author's preferred method of repair for neonatal bilateral choanal atresia.