Choanal atresia is a birth defect that obstructs one or both nasal airways. It can be caused by genetic problems and can lead to serious health issues. Unilateral atresia may not be apparent at birth, while bilateral atresia requires immediate surgery. Surgery involves clearing the blockage and inserting a stent to keep the airways open. Most children recover fully, but additional medical care may be necessary.
Choanal atresia is a birth defect that causes obstruction of one or both nasal airways. A blockage can be caused by an underdeveloped soft tissue layer or a section of palatal bone protruding through the airway. Most children born with unilateral choanal atresia, with an obstruction on only one side, do not have serious health problems. Bilateral choanal atresia, however, is a medical emergency that usually requires immediate surgery to prevent respiratory failure.
Doctors aren’t sure of the exact causes of choanal atresia, although it has been associated with a number of different genetic problems. In healthy fetuses, the nasal airways begin to develop in the second month of gestation and are fully formed well before birth. Many cases of choanal atresia appear when a fetus has a chromosomal disorder, such as Down syndrome or trisomy 18, that also affects the development of other structures and organs. A child could have congenital heart defects, lung problems, cognitive disabilities, or abnormally shaped eyes and ears.
Unilateral choanal atresia may not be apparent at birth, especially if no other defects are present. A child may not be diagnosed with the condition until later in life during unrelated medical testing. Bilateral atresia is usually evident right away, as a baby is unable to breathe properly at birth. Newborns typically breathe through their noses except when they cry, although this is not possible with a bilateral blockage. A baby may have blue lips and skin and be unable to feed without coughing.
A doctor who suspects choanal atresia usually does a computed tomography scan to confirm the presence of an obstruction. If a bilateral blockage is found, the newborn is usually given a tracheal tube to help him breathe and prepare for emergency surgery. The procedure to clear a blockage can be done through the nose or mouth, depending on the size, location and type of tissue structure involved. Soft tissue can usually be punctured and removed through the nostrils, but a palatal bony obstruction may need to be removed through an incision made in the back of the mouth.
Once the blockage is cleared, the surgeon can insert a stent to keep the nasal airways open until the surrounding tissue has time to heal. The stents are usually removed in one to two months after surgery. Most children experience full recoveries from choanal atresia surgery, although additional medical care or surgery may be required if other health problems persist.
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