Hostname: page-component-77c89778f8-7drxs Total loading time: 0 Render date: 2024-07-19T03:36:20.876Z Has data issue: false hasContentIssue false
  • English
  • Français

Cross-over septal flap technique for choanal atresia surgery in two centres: how I do it

Published online by Cambridge University Press:  14 December 2022

H A Elhassan Open the ORCID record for H A Elhassan [Opens in a new window] ,
A Karligkiotis Open the ORCID record for A Karligkiotis [Opens in a new window] ,
K Searyoh ,
J Zocchi Open the ORCID record for J Zocchi [Opens in a new window] ,
G Bozkurt Open the ORCID record for G Bozkurt [Opens in a new window] ,
F Bandi ,
M Birss Open the ORCID record for M Birss [Opens in a new window] ,
G Adegboyega Open the ORCID record for G Adegboyega [Opens in a new window] ,
M Turri-Zanoni  and
P Battaglia
...Show all authors
H A Elhassan*
Affiliation:
ENT Department, Homerton University Hospital, London, UK
A Karligkiotis
Affiliation:
Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
K Searyoh
Affiliation:
ENT Department, Korle Bu Teaching Hospital, Accra, Ghana
J Zocchi
Affiliation:
Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
G Bozkurt
Affiliation:
Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
F Bandi
Affiliation:
Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
M Birss
Affiliation:
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
G Adegboyega
Affiliation:
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
M Turri-Zanoni
Affiliation:
Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
P Battaglia
Affiliation:
Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
M Bignami
Affiliation:
Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
P Castelnuovo
Affiliation:
Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
*
Author for correspondence: Mr Hassan Elhassan, ENT Department, Homerton University Hospital, London E9 6SR, UK E-mail: hassanelhassan@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting.

Methods

This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate.

Results

There were 12 patients from 2013 to 2020, aged 0.07–50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed.

Conclusion

The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis.

Keywords

Choanal AtresiaChildPathologic ConstrictionRetrospective Study
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 8 , August 2023 , pp. 930 - 933
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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.)

Footnotes

Mr H Elhassan takes responsibility for the integrity of the content of the paper

References

Ramsden, JD, Campisi, P, Forte, V. Choanal atresia and choanal stenosis. Otolaryngol Clin North Am 2009;42:339–52CrossRefGoogle ScholarPubMed
Stankiewicz, JA. The endoscopic repair of choanal atresia. Otolaryngol Head Neck Surg 1990;103:931–7CrossRefGoogle ScholarPubMed
Brown, OE, Pownell, P, Manning, SC. Choanal atresia: a new anatomic classification and clinical management applications. Laryngoscope 1996;106:97–101CrossRefGoogle ScholarPubMed
Wormald, PJ, Zhao, YC, Valdes, CJ, Pacheco, AE, Ha, TN, Tewfik, MA et al. The endoscopic transseptal approach for choanal atresia repair. Int Forum Allergy Rhinol 2016;6:654–60CrossRefGoogle ScholarPubMed
Park, AH, Brockenbrough, J, Stankiewicz, J. Endoscopic versus traditional approaches to choanal atresia. Otolaryngol Clin North Am 2000;33:77–90CrossRefGoogle ScholarPubMed
Josephson, GD, Vickery, CL, Giles, WC, Gross, CW. Transnasal endoscopic repair of congenital choanal atresia: long-term results. Arch Otolaryngol Head Neck Surg 1998;124:537–40CrossRefGoogle ScholarPubMed
Gosepath, 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 ScholarPubMed
Samadi, DS, Shah, UK, Handler, SD. Choanal atresia: a twenty-year review of medical comorbidities and surgical outcomes. Laryngoscope 2003;113:254–8CrossRefGoogle ScholarPubMed
Stamm, AC, Pignatari, SS. Nasal septal cross-over flap technique: a choanal atresia micro-endoscopic surgical repair. Am J Rhinol 2001;15:143–8CrossRefGoogle ScholarPubMed
Morgan, DW, Bailey, CM. Current management of choanal atresia. Int J Pediatr Otorhinolaryngol 1990;19:1–13CrossRefGoogle ScholarPubMed
Richardson, MA, Osguthorpe, JD. Surgical management of choanal atresia. Laryngoscope 1988;98:915–18CrossRefGoogle ScholarPubMed
Strychowsky, JE, Kawai, K, Moritz, E, Rahbar, R, Adil, EA. To stent or not to stent? A meta-analysis of endonasal congenital bilateral choanal atresia repair. Laryngoscope 2016;126:218–27CrossRefGoogle ScholarPubMed
Hildenbrand, T, Wormald, PJ, Weber, RK. Endoscopic frontal sinus drainage Draf type III with mucosal transplants. Am J Rhinol Allergy 2012;26:148–51CrossRefGoogle ScholarPubMed
McLeod, IK, Brooks, DB, Mair, EA. Revision choanal atresia repair. Int J Pediatr Otorhinolaryngol 2003;67:517–24CrossRefGoogle ScholarPubMed
El-Guindy, A, El-Sherief, S, Hagrass, M, Gamea, A. Endoscopic endonasal surgery of posterior choanal atresia. J Laryngol Otol 192;106:528–9Google Scholar
Kamel, R. Transnasal endoscopic approach in congenital choanal atresia. Laryngoscope 1994;104:642–6CrossRefGoogle ScholarPubMed
Pasquini, E, Sciarretta, V, Saggese, D, Cantaroni, C, Macrì, G, Farneti, G. Endoscopic treatment of congenital choanal atresia. Int J Pediatr Otorhinolaryngol 2003;67:271–6CrossRefGoogle ScholarPubMed
Saraniti, C, Santangelo, M, Salvago, P. Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis. Braz J Otorhinolaryngol 2017;83:183–9CrossRefGoogle ScholarPubMed
Karligkiotis, A, Farneti, P, Gallo, S, Pusateri, A, Zappoli-Thyrion, F, Sciarretta, V et al. An Italian multicentre experience in endoscopic endonasal treatment of congenital choanal atresia: proposal for a novel classification system of surgical outcomes. J Craniomaxillofac Surg 2017;45:1018–25CrossRefGoogle ScholarPubMed
Durmaz, A, Tosun, F, Yildirım, N, Sahan, M, Kivrakdal, C, Gerek, M. Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. J Craniofac Surg 2008;19:1270–4CrossRefGoogle ScholarPubMed