Case Report: Revision Choanoplasty in a 15-year-old Teenager with Bony and Membranous Type of Bilateral Choanal Atresia

Abstract

Introduction: Choanal atresia is a rare congenital disorder with an incidence of 1:5000 to 1:9000 births and is rarely found in teenager. The incidence is slightly higher in female than male. Bilateral choanal atresia in newborns caused respiratory distress, as they were an obligate nasal breather. They were rarely survived without emergency treatment. A transnasal choanoplasty was the mainstay treatment for choanal atresia. Case report: a 15-years-old male reported with bony and membranous type of bilateral choanal atresia. He initially complained of nasal obstruction and rhinorrhea. There was a history of respiratory distress that was alleviated with crying when he was born. The nasal endoscopic and CT-scan examinations showed septal deviation and bilateral choanal atresia of bony and membranous type in the right and left nasal cavity, respectively. The patient underwent septoplasty before choanoplasty. A stent was used to prevent stenosis. However, one month after choanoplasty, a total restenosis of choana was observed in the right nasal cavity and followed by mild stenosis in left nasal cavity. Further revision of choanoplasty with steroid diluted tamponade and steroid injection in the choanal circumference were done to repair the restenosis. The post-operative evaluation showed a mild restenosis with a patent choana. Conclusion: Treatment of bilateral choanal atresia with a transnasal endoscopy approach facilitates choanoplasty with minimal complications. However, complications in the form of recurrent stenosis after surgery remains to be a challenge.