Choanal atresia

1. Choanal Atresia
ULFAT AMIN
MSc 2nd year

2. INTRODUCTION
• Neonatal airway obstruction leading to respiratory distress is a
fairly common problem in the pediatric ICU setting.
• The word “choana” comes from the Greek word meaning “funnel”.
The choana is essentially the posterior nasal aperture by which air
flows from the nasal cavity into the nasopharynx. The anatomic
borders of the choana are as: -
• Superior border: inferior surface of the sphenoid body –
• Lateral border: lamina of the medial pterygoid plate (inferior
projection of sphenoid bone)
• - Medial border: the nasal vomer
• - Inferior border: horizontal portion of the palatal bone
• The following anatomic abnormalities contribute to forming the
atretic choana: a narrowed nasal cavity, lateral impingement of the
medial pterygoid plate, an abnormally thickened vomer, and a
membrane most of mucosa and/or bone extending across the
choana.

4. • Between 4-6 weeks of gestation, there is a
formation of primitive nasal structures .At
about the same time, nasal pits form and
burrow into the mesenchyme to create the
primitive nasal cavities. These nasal pits sit
atop the frontal portion of the stomodeum (i.e
primitive oral cavity), and the pits are separated
from the stomodeum by the nasobuccal
membrane. Once the nasobuccal membrane
ruptures, the primitive nasal cavity and
primitive choana are formed. The primitive
choana matures and transforms into the
definitive (i.e. secondary) choana

6. HISTORY AND EPIDEMIOLOGY
• Choanal atresia was first described by a physician
named Roederer in 1755.
• However, the first recorded surgical repair was
done in 1854 .
• The condition is the most common nasal
abnormality in newborn infants ,affecting about 1
in 7,000 live births. Females get this condition
about twice as often as males. More than half of
affected infants also have other congenital
problems.
• In general, unilateral choanal atresia is more
common than bilateral (65-75% of patients with
unilateral)

7. Choanal atresia
• Choanal atresia is a rare condition that affects
babies & is caused by a blockage of choana, which is
a passage way that connects each side of nose to
the throat. These passageways are essential for
breathing through the nose. It is a congenital
condition, meaning it is present at birth. the
condition may be present as an isolated birth defect
in a baby that is otherwise healthy or it could be a
part of genetic disorder called charge syndrome
that affect various organs.

8. Two types of Choanal atresia are
UNILATERAL CHOANAL ATRESIA:
this more common of the two & is
also a less threatening, atresia effects
just one side of the nasal
passageways.
BILATERAL CHOANAL ATRESIA:
this can be a life threatening as
blockage affects both passageways,
causing extreme respiratory difficulty

9. Causes
• The cause of choanal atresia is unknown. It is
thought to occur when the thin tissue
separating the nose and mouth area during
fetal development remains after birth. Allergy
and sinus disease with associated secretions
and tissue swelling may contribute as well,
especially in children with cystic fibrosis. In
addition, nasal masses such as hemangiomas
and encephalocoeles must be ruled out in any
child with nasal obstruction.

10. Signs/Symptoms
Bilateral Atresia
• Presents as a newborn
• Cyanosis
• Increased respiratory
effort
• Chest retractions
• Classically
cyanosis/saturations
improve with crying
• Inability to nurse and
breathe at same time.
Uni lateral Atresia
• Present later in life (non-
emergent)
• Chronic nasal discharge
• Nasal obstruction
• Thick nasal secretions on
examination

11. Diagnosis
• A physical exam may show an obstruction of
the nose.
• • Inability to pass catheter or NG tube – 6 Fr –
32 mm as proposed distance
• • Absence of fogging of mirror under nose

12. Diagnosis Choanal Atresia
Tests that may be
done include:
CT scan
Endoscopy of the nose
Sinus x-ray

13. CHARGE Syndrome
• Coloboma ( Essentially a hole
in one of the structures of the
eye.)
• Heart disease (TOF, PDA,
DORV, VSD, ASD, Right Aortic
Arch)
• Atresia choanae
• Retarded growth (CNS
anomalies)
• Genital anomalies
(hypogonadism)
• Ear anomalies

14. Treatment
Resuscitate the baby if necessary.
An airway may need to be placed so that the
infant can breathe. In some cases, intubation
or tracheostomy may be needed.
Surgery to remove the obstruction cures the
problem. Surgery may be delayed if the infant
can tolerate mouth breathing. The surgery
may be done through the nose (transnasal) or
through the mouth (transpalatal). Most
bilateral can be done within the first few days
of life to aid in growth and development

15. Timing of Surgical Repair
• Most bilateral can be done within the first few
days of life to aid in growth and development
• CHARGE syndrome may require a delay
– Tracheostomy typically needed
• Unilateral atresia
– Before school age

17. • Outlook (Prognosis)
• Full recovery is expected.
Possible Complications
Aspiration while feeding and attempting to
breathe through the mouth
Respiratory arrest
Re narrowing of the area after surgery

18. NURSING MANAGEMENT
 Consider CA in newborn/child with symptoms of nasal
obstruction
 There is high association of choanal atresia with other
congenital defects, nurse must look for other defects also
 Oxygen therapy is given for respiratory distress by use of
special nipple called a McGovern nipple which has a
large hole in its center for air passage or a plastic oral
airway piece.
 Input output should be maintained before and after
surgery
 Keep the client warm.
 An intravenous drip is used to hydrate the patient.
 Monitor patients vital signs
 Provide oxygen in case of dyspnea and cyanosis

19. NURSING MANAGEMENT
• All drugs to be administered keeping in mind five
steps of drug administration
• Suction the nasal stents so that they don’t get
blocked up
• Teach parents also how to suction to keep stent
patent for period of three months after surgery
till stent will be removed
• Nurse must teach how to keep nose clean & how
to give your baby nose drops
• Make sure clients nasal passage is patent before
starting feed.

20. • THANK YOU