Atresia, choanal

• Most common congenital anomaly of the nose
• 1/7000 live births
• Unilateral or bilateral bony (90%) or membranous (10%) septum between the nose and the pharynx
• Nearly 50% have other congenital anomalies, more frequently in the bilateral cases

Clinical

• if unilateral, may not present early, i.e. until 1st respiratory infection
• if bilateral, and if difficulty w/ mouth breathing, often: suck in lips and develop cyanosis

Dx

• Inability to pass a firm catheter through each nostril 3-4 cm into the nasopharynx

Tx

• provide oral airway/keep mouth open/intubate i.e. OG tube
• or use a feeding nipple w/ large holes at the tip
• then feed by gavage
• IF bilateral, consider intubation or trachetomy
• operative correction of unilateral obstruction can be deferred for several years
• restenosis is common

also see CHARGE syndrome