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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: mohamedtomoum@yahoo.com
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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 

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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