Objective: To describe and evaluate the surgical effect and prognosis of nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants. Methods: The clinical data of 38 newborns and infants with congenital choanal atresia who underwent nasal endoscopic surgery in Beijing Children's Hospital between January 2016 and May 2018 were retrospectively analysed, including 13 males and 25 females. The age ranged from 5 days to 3 years old at the time of operation (15 cases were newborns). The clinical data, imaging data, treatment effect and prognosis were collected. According to the different surgical methods, the patients were divided into the conventional operation group and the modified mucosal flap technique group. The designs of the modified mucosal flap technique were designed according to the type of congenital choanal atresia. The cross-over L-shaped flaps were performed in patients with unilateral atresia, and the mirrored L-shaped flaps were performed in patients with bilateral atresia. All the patients were followed up for 2-3 years, and the follow-up parameters included the times of operations, length of hospital stay, restenosis rate and incidence of complications. Study data was analyzed using SAS version 9.4 statistical software. Results: Sixteen cases underwent conventional operation while 22 patients underwent modified mucosal flap technique under nasal endoscope. The lightest weight (2 200 g) and the youngest age (5 days) of the patients came from the modified mucosal flap technique group. Compared with the conventional operation group under nasal endoscope, the modified mucosal flap technique group had fewer times of operations (1.14±0.47 vs 2.69±1.20, t=5.552, P<0.001), shorter hospital stay ((7.70±3.22) d vs (14.37±19.16) d, t=2.960, P=0.005), lower rate of postoperative restenosis (9.1% vs 43.8%, χ²=6.156, P=0.013), and lower rate of the incidence of complications (13.6% vs 43.8%, χ²=5.955, P=0.015), the differences were statistically significant. Conclusion: The nasal endoscopic modified mucosal flap technique is feasible for repairing congenital choanal atresia in newborns and infants, which can significantly reduce the incidence of postoperative restenosis and complications.
Child ; Child, Preschool ; Choanal Atresia/surgery* ; Endoscopy ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Nasal Cavity ; Nose ; Retrospective Studies ; Stents

Congenital posterior choanal atresia is a rare congenital deformity. Due to the influence of nose and face and intellectual development, its preferred surgical treatment. But surgical treatment methods and technology are in dispute. The using of high resolution display systems combine with micro tools can effectively reduce postoperative scarring and adhesion formation which is the key point to prevent restenosis. There is also the focus of controversy whether should place an expansive tube after operation. Currently nasal endoscopic approach has become the first choice for otolaryngologist treating congenital posterior choanal atresia.
Choanal Atresia ; pathology ; surgery ; Humans ; Nose ; Otorhinolaryngologic Surgical Procedures

OBJECTIVE: To explore the effects of septonasal bidirectional mucoperiosteal flap in the treatment of refractory choanal atresia in adults. METHOD: Analysis of 9 cases for choanal atresia was conducted. Two cases were of congenital origin and 7 cases of acquired origin, which was a complication of radiotherapy for nasopharyngeal carcinoma. The patients received transnasal endoscopic surgery using the septonasal bidirectional mucoperiosteal flap, without positioning the postoperative expansion tube. After the operation, the changes of symptoms were observed and the recurrent rate of restenosis or atresia was investigated in the follow-up time. RESULT: The symptoms of nasal obstruction and mouth breathing improved significantly in the 9 patients. At an average follow-up time of 19.3 months, the new forming posterior nare remained patent. The mucoperiosteal flap had no shift or necrosis. No restenosis or atresia happened. Nasal adhesion occurred in two patients. Granulation tissue hyperplasia was found in 1 patient, who underwent endoscopic revision without recurrence. CONCLUSION The application of mucoperiosteal flap in transnasal endoscopic surgery for the choanal atresia can reduce the incidence of restenosis or atresia. Postoperative expansion tube is not mandatory.
Adult ; Carcinoma ; Choanal Atresia ; etiology ; surgery ; Endoscopy ; Female ; Humans ; Hyperplasia ; Male ; Nasal Cavity ; Nasal Obstruction ; etiology ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; Necrosis ; Postoperative Period ; Radiation Injuries ; complications ; Recurrence ; Surgical Flaps ; transplantation

Adult ; Choanal Atresia ; etiology ; therapy ; Constriction, Pathologic ; etiology ; Humans ; Male ; Nasopharyngeal Diseases ; etiology ; therapy ; Otorhinolaryngologic Surgical Procedures ; adverse effects ; Palate ; surgery ; Postoperative Complications ; therapy ; Uvula ; surgery

BACKGROUNDThere are congenital and acquired choanal atresias and many approaches have been used for their repair. We assessed the clinical effect of power instrument, endoscopic repair of acquired choanal stenosis and atresia.

METHODSNineteen patients, aged from 32 to 61 years, with acquired choanal stenosis and atresia (from trauma in 5 cases and from radiotherapy after nasopharyngeal carcinoma in 14; 6 bilateral and 13 unilateral cases), underwent transnasal endoscopic repair of choanal stenosis and atresia. No patient had stenting. Antibiotic and local glucocorticoid were administered postoperatively.

RESULTSEighteen patients remained free of symptoms for 12 - 40 months after the surgery, and the diameter of the neochoana was more than 1 cm after the procedure. One patient required revision surgery and recovered completely with no restenosis at 12 months after the second surgery. There were no postoperative complications. Histology of the resected tissue revealed respiratory epithelial-lined stromal tissue with chronic inflammation, edema and fibrosis, but no tumor cells.

CONCLUSIONSTransnasal endoscopic approach is a useful procedure for the repair of acquired choanal stenosis and atresia: it is highly successful, safe and effective with swift recovery and short time of hospitalization. It is very important in postoperative care to remove any granulation or polyps at the site of the neochoana at that time.

Adult ; Choanal Atresia ; pathology ; surgery ; Constriction, Pathologic ; surgery ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nasal Cavity ; pathology ; surgery ; Treatment Outcome