Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-03T02:49:23.819Z Has data issue: false hasContentIssue false
  • English
  • Français

Stentless mirrored L-shaped septonasal flap versus stented flapless technique for endoscopic endonasal repair of bilateral congenital choanal atresia: a prospective randomised controlled study

Published online by Cambridge University Press:  16 January 2018

M O Tomoum ,
M H Askar ,
M F Mandour ,
M A Amer  and
M E Saafan
M O Tomoum*
Affiliation:
Otolaryngology – Head and Neck Surgery Department, Faculty of Medicine, Tanta University, Egypt
M H Askar
Affiliation:
Otolaryngology – Head and Neck Surgery Department, Faculty of Medicine, Tanta University, Egypt
M F Mandour
Affiliation:
Otolaryngology – Head and Neck Surgery Department, Faculty of Medicine, Tanta University, Egypt
M A Amer
Affiliation:
Otolaryngology – Head and Neck Surgery Department, Faculty of Medicine, Tanta University, Egypt
M E Saafan
Affiliation:
Otolaryngology – Head and Neck Surgery Department, Faculty of Medicine, Tanta University, Egypt
*
Address for correspondence: Dr Mohamed Osama Tomoum, Otolaryngology – Head and Neck Surgery Department, Faculty of Medicine, Tanta University, Tanta, El-Gharbiya, Egypt E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To compare the outcomes of endoscopic repair of bilateral congenital choanal atresia using a flap technique without stenting versus endoscopic repair using stenting without a flap.

Methods:

A prospective randomised controlled study was conducted, comprising 72 patients with bilateral congenital choanal atresia. The patients were randomised into two groups. Group A (42 patients) underwent endoscopic repair using a mirrored L-shaped flap without stenting, and group B (30 patients) underwent endoscopic repair using stenting without a flap.

Results:

At a mean follow-up period of 18.2 months, endoscopic assessment revealed a patent posterior choana in 81 per cent and 83.33 per cent of patients in group A and group B respectively. Choanal stenosis occurred in 21.40 per cent and 33.33 per cent of patients in group A and group B respectively. Granulation tissue was observed in 28.6 per cent and 53.3 per cent of patients in group A and group B respectively.

Conclusion:

The endoscopic approach utilising a flap without stenting is safe and effective, with a high success rate.

Keywords

Choanal AtresiaBilateral Nasal ObstructionStentsOutcome MeasuresCHARGE Syndrome
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 4 , April 2018 , pp. 329 - 335
Copyright
Copyright © JLO (1984) Limited 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Ravindhra, G, Elluru, SV. Congenital malformations of the nose and paranasal sinuses. In: Stucker, FJ, Kenyon, GS, Lian, TS, Draf, W, Schick, B, eds. Rhinology and Facial Plastic Surgery. Dordrecht: Springer, 2009;123–38Google Scholar
2Brown, OE, Pownell, P, Manning, SC. Choanal atresia: a new anatomic classification and clinical management applications. Laryngoscope 1996;106:97–101CrossRefGoogle ScholarPubMed
3Park, AH, Brockenbrough, J, Stankiewicz, J. Endoscopic versus traditional approaches to choanal atresia. Otolaryngol Clin North Am 2000;33:77–90CrossRefGoogle ScholarPubMed
4Josephson, GD, Vickery, CL, Giles, WC, Gross, CW. Transnasal endoscopic repair of congenital choanal atresia: long-term results. Arch Otolaryngol Head Neck Surg 1998;124:537–40Google Scholar
5Harrison, M, Calvert, ML, Longhurst, P. Solitary maxillary central incisor as a new finding in CHARGE association: a report of two cases. Int J Paediatr Dent 1997;7:185–9Google Scholar
6Carpenter, RJ, Neel, HB. Correction of congenital choanal atresia in children and adults. Laryngoscope 1977;87:1304–11CrossRefGoogle ScholarPubMed
7Freng, A. Surgical treatment of congenital choanal atresia. Ann Otol Rhinol Laryngol 1978;87:346–50Google Scholar
8Krespi, YP, Husain, S, Levine, TM, Reede, DL. Sublabial transseptal repair of choanal atresia or stenosis. Laryngoscope 1987;97:1402–6Google Scholar
9Hall, WJ, Watanabe, T, Kenan, PD, Baylin, G. Transseptal repair of unilateral choanal atresia. Arch Otolaryngol 1982;108:659–61CrossRefGoogle ScholarPubMed
10Owens, H. Observations in treating twenty-five cases of choanal atresia by the transpalatine approach. Laryngoscope 1965;75:84–104Google Scholar
11Stankiewicz, JA. The endoscopic repair of choanal atresia. Arch Otolaryngol Head Neck Surg 1990;103:931–7CrossRefGoogle ScholarPubMed
12Schoem, SR. Transnasal endoscopic repair of choanal atresia: why stent? Otolaryngol Head Neck Surg 2004;131:362–6CrossRefGoogle ScholarPubMed
13Pasquini, E, Sciarretta, V, Saggese, D, Cantaroni, C, Macri, G, Farneti, G. Endoscopic treatment of congenital choanal atresia. Int J Pediatr Otorhinolaryngol 2003;67:271–6Google Scholar
14Khafagy, YW. Endoscopic repair of bilateral congenital choanal atresia. Laryngoscope 2002;112:316–19CrossRefGoogle ScholarPubMed
15Sharma, RK, Lee, CA, Gunasekaran, S, Knight, LC, Bielby, M. Stenting for bilateral congenital choanal atresia--a new technique. Int J Pediatr Otorhinolaryngol 2006;70:869–74Google Scholar
16Osguthorpe, JD, Singleton, GT, Adkins, WY. The surgical approach to bilateral choanal atresia. Analysis of 14 cases. Arch Otolaryngol 1982;108:366–9CrossRefGoogle ScholarPubMed
17Holzmann, D, Ruckstuhl, M. Unilateral choanal atresia: surgical technique and long-term results. J Laryngol Otol 2002;116:601–4Google Scholar
18Richardson, MA, Osguthorpe, JD. Surgical management of choanal atresia. Laryngoscope 1988;98:915–18CrossRefGoogle ScholarPubMed
19Samadi, DS, Shah, UK, Handler, SD. Choanal atresia: a twenty-year review of medical comorbidities and surgical outcomes. Laryngoscope 2003;113:254–8CrossRefGoogle ScholarPubMed
20Van Den Abbeele, T, Francois, M, Narcy, P. Transnasal endoscopic treatment of choanal atresia without prolonged stenting. Arch Otolaryngol Head Neck Surg 2002;128:936–40Google Scholar
21Gosepath, J, Santamaria, VE, Lippert, BM, Mann, WJ. Forty-one cases of congenital choanal atresia over 26 years--retrospective analysis of outcome and technique. Rhinology 2007;45:158–63Google Scholar
22Durmaz, A, Tosun, F, Yldrm, N, Sahan, M, Kvrakdal, C, Gerek, M. Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. J Craniofac Surg 2008;19:1270–4Google Scholar
23Cedin, AC, Atallah, AN, Andriolo, RB, Cruz, OL, Pignatari, SN. Surgery for congenital choanal atresia. Cochrane Database Syst Rev 2012;(2):CD008993CrossRefGoogle ScholarPubMed
24Zuckerman, JD, Zapata, S, Sobol, SE. Single-stage choanal atresia repair in the neonate. Arch Otolaryngol Head Neck Surg 2008;134:1090–3Google Scholar
25Cedin, AC, Fujita, R, Cruz, OL. Endoscopic transeptal surgery for choanal atresia with a stentless folded-over-flap technique. Otolaryngol Head Neck Surg 2006;135:693–8Google Scholar
26Gujrathi, CS, Daniel, SJ, James, AL, Forte, V. Management of bilateral choanal atresia in the neonate: an institutional review. Int J Pediatr Otorhinolaryngol 2004;68:399–407CrossRefGoogle ScholarPubMed
27Shivakumar, AM, Naik, AS, Prashanth, KB, Vishwanath, B, Praveen, DS. Choanal atresia: transnasal endoscopic technique. Indian J Pediatr 2003;70:875–6CrossRefGoogle ScholarPubMed
28McLeod, IK, Brooks, DB, Mair, EA. Revision choanal atresia repair. Int J Pediatr Otorhinolaryngol 2003;67:517–24Google Scholar
29Rombaux, P, de Toeuf, C, Hamoir, M, Eloy, P, Bertrand, B, Veykemans, F. Transnasal repair of unilateral choanal atresia. Rhinology 2003;41:31–6Google Scholar
30Gulsen, S, Baysal, E, Celenk, F, Aytac, I, Durucu, C, Kanlikama, M et al. Treatment of congenital choanal atresia via transnasal endoscopic method. J Craniofac Surg 2017;28:338–42Google Scholar