CHOANAL ATRESIA
Historical Background
• In 1755, Roederer first described congenital choanal atresia; therefore, this condition has been recognized for more than 200 years.
• .
DEFINITION
Developmental failure of the nasal cavity to communicate with the nasopharynx.
• Rare congenital anomily
• 1 in 5000 to 8000 live births
• Female male ratio is 2:1
Epidemiology• Occurs in ~1 in 5,000 – 7,000 live births
• More common in girls than boys
• Slightly increased risk exists in twins.
• Maternal age or parity does not increase the
frequency of occurrence.
• Chromosomal anomalies are found in 6% of infants with choanal atresia.
• • Choanal atresia occurs with equal
frequency in people of all races
ASSOCIATIONS
CHARGE ASSOCIATION• Coloboma • Heart disease• Atresia of choanae• Retarded G and D• Genital hypoplasia• Ear deformities or deafness
EMBRYOGENESIS
• Theory 1• Hochstaller or buccopharyngeal
membrane from foregut
• Rupture of membrane 5 -6 week of gestation
• Forms choanae
• Theory 2• Abnormal persistence of mesoderm• Adhesions of the region• Atesia
Etiology
• By the 38th day of development, the 2-layer membrane consisting of nasal and oral epithelia ruptures and forms the choanae (posterior nares).
• Failure of this rupture results in choanal atresia.
• In 2008, Barbero et al suggested that prenatal use of antithyroid (methimazole, carbimazole) medications was linked to choanal atresia.
TYPES
UNILATERAL
BILATERAL
TYPE 2
• BONY MIXED
TYPES
• CONGENITAL
• ACQUIRED
Clinical manifestations
BILATERAL• Complete nasal obstruction• Immediate respiratory distress• Potential death due to asphyxia• Cyclic respiratory obstruction• Child cries opens the mouth • obstruction is relieved
UNILATERAL
• Rarely causes respiratory distress• Mucoid discharge
• OTHER MANIFESTATIONS• Feeding difficulty• Respiratory collapse• Failure to thrive
DIAGNOSIS
• Physical examination• Passing of a feeding tube through nose
• Observing misting on a metal spatula or laryngeal mirror
• Placing methylene blue in nasal cavity
• Endoscopic examination
RADIOGRAPHY
Acoustic rhinometry
• new technique which evaluates nasal obstruction by analysing reflections of a sound pulse introduced via the nostrils.
Computed tomography
Diagnosis Confirmation• Confirmed with CT
with intranasal contrast that shows narrowing of the posterior nasal cavity
MANAGEMENT
• IMMEDIATE MANAGEMENT• Breathe through mouth• Mc govern nipple• Oropharyngeal airway
Mc Govern nipple
Oropharyngeal airway
ENDOTRACHEAL INTUBATION
TRACHEOSTOMY
UNILATERAL
SURGICAL REPAIR
• TRANSNASAL APPROACH
• TRANSPALATAL APPROACH
TRANSNASAL APPROACH
TRANSPALATAL APPROACH-
STENT PLACEMENT
ENDOSCOPIC CHOANOPLASTY WITHOUT
STENT PLACEMENT
COMPLICATIONS
• INFECTIONS• BLEEDING• GROWTH PROBLEMS• SCARRING• RESTENOSIS
NURSING MANAGEMENT
• Assessment• Diagnosis• Planning• Intervention• Evaluation
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