Congenital atresia of posterior nares: Diagnosis and treatment at Hilla, Iraq

Background: Atresia of posterior nares (choana) is a congenital condition in which the posterior nares fail to develop either bilaterally or unilaterally. Objectives: The aim of this article is to show different methods of diagnosis and surgical procedures used for management in our department. Materials and Methods: In this study, 21 patients were included. It is a retrospective study form. The confirmation of the diagnosis is by failure of 6–8-F tube catheter to pass; CT scan of posterior choana shows the type and thickening of atretic plate (cartilage or bone), and endoscopic examination confirms it. Results: Female patients were 15, whereas male patients were 6. Age range was from 1 day to 25 years. All of the patients were within the pediatric age group except one adult patient. Unilateral cases were found in 14 patients, while 7 patients had bilateral atresia. Bilateral atresia was presented within early day life (1–3 days). They were five females and two males. The unilateral cases diagnose at a later life period (4–25 years). There were 4 males and 10 females. Proved by CT scan, mixed bony and membranous atresia were in 18 patients, bony atresia was in 3 patients, and there was no pure membranous atresia. Thirteen of the unilateral cases involved right side, while only one case had left-side atresia (7.6%). Three cases of bilateral atresia had other congenital anomalies (14%). Ten patients were treated by nonendoscopic (transnasal) surgical approach (five of them had bilateral and unilateral atresia, respectively). Endoscopic trans-septal approach was done in two patients, both had bilateral atresia. Nine patients were treated by transnasal endoscopic method. Stent was used in 13 patients postoperatively for 4–6 weeks. Two patients required revision surgery for restenosis. Conclusion: Endoscopic transnasal approach is the proper way in the surgical treatment of atresia because it is more accurate, under surgeon vision, less invasive with less morbidity in spite of longer time to perform.