Posterior septectomy in transnasal endoscopic choanoplasty

Congenital choanal atresia [CA] is a challenging surgical problem. Choosing between the transnasal and transpalatal routes is still a controversial feature in the surgical management of CA. The purpose of this study was to evaluate the results of transnasal endoscopic choanoplasty with versus without posterior septectomy. Thirteen patients were included in this study [8 females and 5 males] aged 3 days to 17 years [mean age 4.06 years], 7 cases with bilateral CA and 6 cases with unilateral CA who underwent surgical repair at Al-Azhar university hospitals between 2004 and 2008. All patients underwent transnasal endoscopic repair using powered instrument. The first 5 cases had repair without posterior septectomy, while the last 8 cases had repair with posterior septectomy. All cases were stented for 4 to 6 weeks and followed for at least 10 months. Postoperatively, 11 patients [84.6%] had successful repair, while 2 cases [15.4%] had restenosis which needed revision surgery. Restenosis occurred in 2 of the 5 cases who underwent repair without posterior septectomy. No restenosis in patients who underwent repair with posterior septectomy. One patient developed pressure necrosis of the palate few days after surgery, which healed after replacement of the stent by a smaller one