[Choanal atresia in an alpaca cria (Vicugna pacos)]. / Choanenatresie bei einem Alpakacria (Vicugna pacos).

After birth, an alpaca cria was noticed to exhibit weakness and respiratory distress, particularly when attempting to suckle milk from the dam's udder. Clinical findings indicated the presence of bilateral choanal atresia and the animal was subsequently euthanised. A computed tomography scan and a pathological examination were performed to describe the malformation in detail. Choanal atresia is a common malformation in neonatal South American camelids, surgical treatment is not recommended. This case report provides an overview of the clinical findings as well as the results of imaging and pathologic examinations and may help to raise awareness of this malformation for early recognition.

Pädiatrische Rhinologie. / Pädiatrische Rhinologie.

The following review article highlights key topics in pediatric rhinology that are currently the focus in research and at conferences as well as in the interdisciplinary discussion between otorhinolaryngologists and pediatricians. In particular, congenital malformations such as choanal atresia or nasal dermoid cysts are discussed, followed by statements on the current procedures for sinogenic orbital complications as well as on the diagnosis and therapy of chronic rhinosinusitis in children. Furthermore, updates on the role of the ENT specialist in the care for children with cystic fibrosis and primary ciliary dyskinesia are provided.

Dacryocystocele and Subsequent Dacryocystectomy in a Patient With Bosma Arhinia Microphthalmia Syndrome (BAMS): A Case Report and Review of Literature.

Bosma arhinia microphthalmia syndrome (BAMS) is a rare syndrome consisting of several craniofacial abnormalities, including congenital arhinia. In this case report, the authors present the first case of a patient with BAMS and dacryocystocele who successfully underwent dacryocystectomy. Dacryocystectomy may serve as a viable surgical approach for dacryocystocele in patients with abnormal nasal anatomy. [J Pediatr Ophthalmol Strabismus. 2024;61(3):e16-e18.].

Atresia de coana unilateral: reporte de un caso pediátrico / Unilateral coana atresia. A pediatric case report

La atresia de coanas se caracteriza por la obliteración de la abertura nasal posterior. Es la anomalía congénita más frecuente de las fosas nasales. Tiene una incidencia de 1 cada 5000 a 7000 neonatos, con predominio en el sexo femenino. Puede presentarse en forma aislada o asociada a otros síndromes como el CHARGE (coloboma [C], malformaciones cardíacas [H], atresia de coanas [A], retraso psicomotor y/o en el crecimiento [R], hipoplasia de genitales [G], malformaciones auriculares y/o sordera [E, por su sigla en inglés]). Las manifestaciones clínicas son la obstrucción nasal, cianosis y dificultad respiratoria desde el nacimiento cuando es bilateral. Las atresias unilaterales se caracterizan por insuficiencia ventilatoria nasal y rinorrea unilateral, y pueden pasar inadvertidas. El diagnóstico se realiza mediante endoscopia y estudios por imágenes. El tratamiento es quirúrgico; existen diferentes técnicas y vías de abordaje. Se presenta el caso de un paciente masculino de 7 años con atresia unilateral de coana derecha con resolución microendoscópica, colocación de tutor externo, con buena resolución.

Choanal atresia is characterized by obliteration of the posterior nasal opening. It is the most common congenital anomaly of the nasal passages. It has an incidence of 1 in 5000 to 7000 newborns; predominantly female. It can occur in isolation or in association with other syndromes such as CHARGE (coloboma [C], cardiac malformations [H], choanal atresia [A], psychomotor and/or growth retardation [R], genital hypoplasia [G], atrial malformations and/or deafness [E]. Clinicallypresents nasal obstruction, cyanosis and respiratory distress from birth when bilateral, unilateral atresias are characterized by nasal ventilatory insufficiency and unilateral rhinorrhea, which may go unnoticed. Diagnosis is made by endoscopy and imaging tests. Treatment is surgical, with different techniques and approaches.A 7-year-old male patient is presented with unilateral atresia of the right choana with microendoscopic resolution, placement of an external tutor, with good resolution.

Atresia congénita bilateral de coanas en una adolescente: reporte de un caso / Congenital bilateral choanal atresia in an adolescelent: a case report

La atresia congénita de coanas se caracteriza por la presencia de placas que obliteran la comunicación entre la cavidad nasal y la nasofaringe desde el nacimiento. Se considera como incompatible con la vida cuando la condición es bilateral. El siguiente es el caso de una paciente femenina, de 17 años, sin síndromes asociados, con obstrucción y descarga nasal anterior bilateral, asociado a respiración oral desde el periodo neonatal. El diagnóstico de atresia bilateral de coanas fue confirmado por medio de endoscopía nasal y tomografía computarizada (TC). La imagen confirmó la presencia de placas atrésicas de composición mixta. La paciente recibió tratamiento quirúrgicamente por vía transnasal con resección de las placas y modelado de neocoana.

Congenital choanal atresia is characterized by the presence of plates obliterating the communication between the nasal cavity and the nasopharynx from birth. If bilateral, this condition is incompatible with life. This following is the case of a 17-year-old female patient, without associated syndromes, with bilateral nasal obstruction and anterior discharge, associated to oral breathing, starting in her neonatal period. The diagnosis of bilateral choanal atresia was confirmed by nasal endoscopy and computed tomography (CT) scan, due to the presence of atretic plates of mixed composition. The patient was surgically treated with plate resection and modeling of a neochoana by means of a transnasal surgical approach.

Estenosis de la apertura piriforme y síndrome de incisivo central único: casos clínicos / Piriform aperture stenosis and solitary median maxillary central incisor: clinical cases

El síndrome incisivo central único es un trastorno que involucra anomalías de la línea media. Se puede presentar con dificultad respiratoria poniendo en peligro la vida del recién nacido, debido a malformaciones nasales. Estas malformaciones incluyen atresia de coanas y la estenosis de la apertura del orificio piriforme. Debe pensarse en esta última en todo recién nacido con estridor y dificultad respiratoria de grado variable, asociado a la dificultad de pasar una sonda a través de la región anterior de las fosas nasales. El diagnóstico se confirma por tomografía computarizada del macizo craneofacial y el examen nasofibroscópico. La conducta terapéutica dependerá de la gravedad de los síntomas, pero en general si es que no hay compromiso respiratorio severo, se prefiere una conducta expectante, y esperar el crecimiento craneofacial del niño, para aumentar permeabilidad nasal. Presentamos dos casos clínicos.

Solitary median maxillary central incisor syndrome is a rare disorder involving midline abnormalities. It may present with life threatening respiratory distress in the neonate secondary to nasal malformations. These include choanal atresia and pyriform aperture stenosis. The last to be thought in any newborn with stridor and respiratory distress associated with the difficulty of passing a tube through the anterior region of the nostrils. The diagnosis is confirmed by craniofacial CT scan and nasolaryngoscope evaluation. The therapeutic approach depends on the severity of symptoms.

Atresia de coana unilateral: o uso de molde na cirurgia da reestenose / Unilateral choanal atresia: the use of cast in surgery for restenosis

Introdução: A atresia de coana (AC) é a anomalia nasal congênita mais comum. Estima-se a incidência de 1 caso para cada 8000-10000 nascidos vivos. Relato do caso: Paciente feminina, 9 anos, com obstrução nasal em fossa nasal direita (FND) desde o nascimento. Apresentava roncos e apneia em vigência de infecção de via aérea superior. À rinoscopia anterior direita, secreção hialina abundante. À videonasoendoscopia flexível não foi possível visualizar cavum pela FND, observando-se estase de secreção em região posterior; à esquerda cavum livre, sem lesão expansiva. Tomografia de nariz e seios paranasais evidenciou atresia de coana mista à direita. Foi realizada cirurgia para correção da malformação. Após 30 dias, observou-se reestenose do cavum. Na reintervenção, a coana foi ampliada com remoção do osso palatino e do septo posterior, realizada dilatação com balão e posicionado molde de silicone. Realizada aplicação de Mitomicina. A remoção do molde foi feita em bloco cirúrgico após 42 dias, com permeabilidade coanal preservada. Nasofibroendoscopia após 6 meses mostrou fossas nasais pérvias. Discussão: Ainda há controvérsias na literatura quanto à efetividade das diferentes técnicas cirúrgicas e ao uso de stents e de agentes antineoplásicos no pós-operatório. Neste relato, a dilatação com balão pode ter contribuído para o sucesso da cirurgia, porém o molde foi fundamental para evitar a reestenose. Considerações finais: O uso do molde mostrou um excelente resultado nesta reintervenção de correção de atresia de coana. A baixa reação inflamatória e o sucesso do pós-operatório mostraram que esta é uma opção a ser utilizada para evitar a reestenose (AU)

Introduction: Choanal atresia (CA) is the most common congenital nasal anomaly. Its incidence is estimated as 1 case for every 8,000-10,000 live births. Case report: Female patient, 9 years old, with obstruction in the right nasal cavity (RNC) since birth. She presented snoring and apnea in the presence of upper airway infection. At right anterior rhinoscopy, abundant hyaline secretion. Flexible videonasoendoscopy failed to visualize cavum through RNC, with secretion stasis in posterior region; left cavum free, without expansive lesion. Tomography of the nose and paranasal sinuses revealed mixed choanal atresia on the right. Surgery was performed to correct the malformation. Thirty days later, restenosis of the cavum was observed. At reoperation the choana was enlarged with removal of the palatine bone and posterior septum, balloon dilatation was performed and a silicone cast was positioned. Mitomycin application was performed. Removal of the cast was done in surgical ward after 42 days, with preserved choanal permeability. Nasofibroscopy at 6 months postoperatively showed permeable nasal cavities. Discussion: There is still controversy in the literature regarding the effectiveness of different surgical techniques and the use of stents and anti-neoplastic agents in the postoperative period. In this report, balloon dilatation may have contributed to the success of the surgery, but the cast was crucial to avoid restenosis. Final considerations: The use of the cast had an excellent outcome in this re-intervention of choanal atresia correction. The low inflammatory reaction and postoperative success have shown that this is an effective option to be used to avoid restenosis (AU)

Atresia de coanas, revisión y una mirada desde la evidencia / Choanal atresia, review and a look from the evidence

La atresia de coanas es la anomalía congénita nasal más común. Cuando es bilateral, se presenta con dificultad respiratoria desde el nacimiento. La atresia unilateral se manifiesta con insuficiencia ventilatoria y rinorrea unilateral, pudiendo pasar inadvertida. El diagnóstico se sospecha ante la ausencia de paso de aire en las fosas nasales y la imposibilidad de hacer progresar una sonda nasogástrica. Se confirma mediante examen endoscópico y tomografía computarizada. El tratamiento definitivo es quirúrgico, existiendo diferentes técnicas y vías de abordaje. Se presenta una revisión de la literatura, con especial énfasis en el tratamiento pos-quirúrgico con stents y mitomicina-C a través de una mirada desde la evidencia.

Choanal atresia is the most common congenital nasal anomaly. When bilateral, it presents with respiratory distress at birth. Unilateral atresia is manifested by respiratory failure and unilateral rhinorrhea, and may go along unnoticed. Diagnosis is suspected in the absence of airflow in the nasal cavity and for the inability to advance a nasogastric tube. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and there are different techniques and surgical approaches. A review of the literatureis presented, with special emphasis onthepost-surgical treatmentwithstents and Mitomycin-Cview from the evidence.

Atresia coanal bilateral em paciente de 34 anos / Bilateral choanal atresia in 34 year-old patients

Introdução: A atresia de coanas (AC) pode ser definida como a falha no desenvolvimento da comunicação entre a cavidade nasal e a nasofaringe. Pode ocorrer como uma placa ósteo-membranosa, óssea ou membranosa. O diagnóstico depende de alto grau de suspeição clínica e exames complementares, o tratamento é cirúrgico. Objetivo: Relatar um caso de uma paciente adulta com diagnóstico de atresia coanal bilateral e que foi submetida a tratamento cirúrgico. Relato do Caso: MLSM, 34 anos,sexo feminino, com história de obstrução nasal bilateral, rinorreia hialina desde a infância. Na endoscopia nasal e Tomografia Computadorizada de seios da face evidenciou atresia ósteo-membranosa bilateral. Paciente foi submetida a tratamento cirúrgico endoscópico via transnasal, com confecção de retalho mucoso cobrindo a área cruenta, sem colocação de stent. Foi feito Tomografia de controle que evidenciou coanas abertas e amplas. Paciente evoluiu bem e apresenta respiração nasal normal. Comentários Finais: A AC bilateral, embora rara, pode ocorrer em pacientes adultos...

Introduction: Choanal atresia (CA) can be defined as a failure to develop the communication between the nasal cavity and nasopharynx. May occur as a plate osteo-membranous, bony or membranous. Diagnosis depends on high clinical suspicion and laboratory tests, treatment is surgical. Objective: To report a case of an adult patient diagnosed with bilateral choanal atresia and underwent surgery. Case Report: MLSM, 34 years old female with a history of bilateral nasal obstruction, rhinorrhea hyaline since childhood. On nasal endoscopy and CT scan of the sinuses showed bilateral membranous atresia osteo. Patient underwent endoscopic transnasal route, with production of mucosal flap covering the wound, without stent placement. Tomography was performed which showed control choanae open and broad. The patient progressed well and has normal nasal breathing. Conclusion: AC bilateral, although rare, can occur in adult patients...

Atresia de coanas, tratamiento quirúrgico endoscópico, 5 años de experiencia / Choanal atresia, endoscopic surgical repair, a 5 year experience

Atresia de coanas es la obstrucción congénita de la región posterior de las fosas nasales. Múltiples técnicas quirúrgicas han sido empleadas para su reparación. En el presente estudio se recopiló la información de 5 años de trabajo en el Hospital Universitario del Valle en la ciudad Santiago de Cali - Colombia, entre los años 2003 y 2008. Se obtuvo un total de 16 casos.La información demográfica documentada incluyó datos como edad, sexo, síntomas iniciales, método diagnóstico, lateralidad, tipo de atresia de coanas, comorbilidades, tratamiento inicial, edad de intervención quirúrgica, técnica quirúrgica usada. La técnica quirúrgica consistió en el fresado y apertura de la placa atrésica vía endoscópica transnasal utilizando taladro, previa realización de colgajos mucosos en cruz y resecando parcialmente paredes del vómer.La experiencia observada en estos 5 años de trabajo demuestra que el abordaje endoscópico transnasal presenta grandes ventajas, entre ellas la baja tasa de reestenosis.

Choanal atresia is a congenital disorder where the back of the nasal passage is blocked. Many surgical techniques have been used to repair this disorder. In this study we collected information from 5 years of work at the Hospital Universitario del Valle in the city of Santiago de Cali - Colombia, between 2003 and 2008. A total of 16 cases were obtained. The documented data included demographic information like age, sex, initial symptoms, diagnostic methods, laterality, type of atresia, comorbilities, initial treatment and surgical technique used. The surgical technique consisted in endoscopic opening of the atretic plate using drill. Mucosal flaps and resection of partial plate of vomer were made previously.The experience observed in these 5 years of work shows that the endoscopic transnasal approach has major advantages, including low restenosis rate.

Uso de guía metálica para intubación traqueal mediante fibroscopia en un neonato con síndrome de Treacher Collins y atresia de coanas / Use of a metal guide in the working channel of a fiberoptic scope to insert a tracheal tube in an infant with Treacher Collins syndrome and choanal atresia

Los neonatos afectos de síndrome de Treacher Collinspueden presentar dificultades en el manejo de la víaaérea. Las malformaciones a nivel del macizo craneofacial,características de este síndrome, implican que laventilación con mascarilla facial y la laringoscopia paraintubación orotraqueal puedan resultar imposibles. Además,el mayor riesgo de obstrucción de la vía aérea quepresentan estos pacientes hace que sea la fibroscopia,con el paciente despierto, el método más adecuado parala intubación orotraqueal. Esta técnica es especialmentedifícil en la población pediátrica y no siempre se disponede material específico para neonatos. Presentamos elcaso de un niño de 5 días de vida con síndrome de TreacherCollins y atresia coanal bilateral en el que se utilizóuna guía metálica flexible, introducida a través del canalde trabajo del fibroscopio para seguidamente insertar eltubo orotraqueal a través de dicha guía(AU)

Neonates with Treacher Collins syndrome can presentdifficult airways. Ventilation through a face mask andlaryngoscopy for tracheal intubation may proveimpossible due to the craniofacial malformations thatare characteristic of this syndrome. Furthermore,patients with this syndrome are at high risk of airwayobstruction, meaning that awake fiberoptic endoscopyprovides the best option for tracheal intubation. Thistechnique is especially difficult in children, however, andmaterial required for performing it in neonates is notalways available. We report the case of a 5-day-oldinfant boy with Treacher Collins syndrome and bilateralchoanal atresia in whom we used a flexible metal guideinserted into the working channel of a fiberoptic scope.The tracheal tube could then be inserted(AU)

Experiencia de 30 años de trabajo en el tratamiento de la imperforación de coanas / Thirthy years of experience in imperforate choana treatment

Se realizó un estudio transversal y retrospectivo sobre los 11 pacientes atendidos en el Servicio de Otorrinolaringología del Hospital infantil Sur de Santiago de Cuba con el diagnóstico de imperforación de coanas, donde se expone la experiencia del equipo médico en el tratamiento de estos niños durante más de 30 años de trabajo (1970-2000).

A retrospective and cross-sectional study was conducted in 11 patients diagnosed with imperforate choanas, who were attended in the Otorhinolaringology Service of the Southern Children Hospital from Santiago de Cuba, where the experience of the medical team in the treatment of these children for more than 30 working years (1970-2000) is stated.

Experiencia de 30 años de trabajo en el tratamiento de la imperforación de coanas / Thirthy years of experience in imperforate choana treatment

Se realizó un estudio transversal y retrospectivo sobre los 11 pacientes atendidos en el Servicio de Otorrinolaringología del Hospital infantil Sur de Santiago de Cuba con el diagnóstico de imperforación de coanas, donde se expone la experiencia del equipo médico en el tratamiento de estos niños durante más de 30 años de trabajo (1970-2000)(AU)

A retrospective and cross-sectional study was conducted in 11 patients diagnosed with imperforate choanas, who were attended in the Otorhinolaringology Service of the Southern Children Hospital from Santiago de Cuba, where the experience of the medical team in the treatment of these children for more than 30 working years (1970-2000) is stated(AU)

Obstrução nasal no recém-nascido: diagnóstico diferencial / Nasal obstruction of the newborn: a differential diagnosis

Introdução: A obstrução nasal é potencialmente grave quando acomete os recém-nascidos, respiradores nasais preferenciais. Os neonatos com obstrução nasal podem apresentar desde um quadro assintomático até uma situação grave de obstrução da via aérea, com cianose cíclica. A cianose piora com alimentação e melhora com choro. Apesar de a causa mais comum de obstrução no neonato ser o edema de mucosa secundário à rinite viral ou à rinite idiopática do lactente, é importante estar atento para o diagnóstico das alterações anatômicas nasais. Embora pouco frequentes, são afecções nas quais o diagnóstico e manejo precoces são fundamentais para evitar, além da obstrução da via aérea, as dificuldades de alimentação com aspiração recorrente. Objetivo: O objetivo da presente série de casos é descrever as três causas mais comuns de obstrução nasal anatômica no neonato: a atresia de coanas, a dacriocistocele e a estenose da abertura piriforme anterior. Considerações Finais: As características clínicas, investigação diagnóstica e tratamento dessas três patologias são apresentadas. Através disso, buscamos alertar para a importância de que a passagem de uma sonda nasal faça parte do exame físico de todo recém-nascido, em especial se ele apresentar disfunção respiratória ao nascimento e/ou cianose às mamadas.

Introduction: The nasal obstruction is potentially severe when affecting newborns, preferential nasal breathers. The newborns with nasal obstruction may present from an asymptomatic affection up to a severe situation of airway obstruction, with cyclical cyanosis. The cyanosis worsens with feeding and improves with crying. Despite the most common cause of obstruction in the newborn is mucosa edema secondary to viral rhinitis or idiopathic rhinitis of the child, it is important to be attentive to the diagnosis of the nasal anatomic alterations. Although not much frequent, they represent affections in which the early diagnosis and management are basic to prevent airway obstruction and feeding difficulties with recurrent aspiration. Objective: The objective of this case report is to describe the three most common causes of anatomic nasal obstruction in newborns: the choanal atresia, dacryocystocele and anterior piriform opening stenosis. Final Comments: The clinical characteristics, diagnostic investigation and treatment of these three pathologies are presented. Therefore, we seek to alert as to the importance that the nasal probe passage be part of the physical exam of every newborn, specially when it has breathing disorder upon birth and/or cyanosis when breastfeeding.

Atresia bilateral de coanas em crianças: relato de caso e revisão da literatura / Bilateral choanal atresia in childhood: case report and literature review

Os autores relatam o caso de um paciente de 14 anos de idade com imperfuração bilateral das coanas ao exame físico e que, à tomografia computadorizada, apresentou sinais compatíveis com atresia das coanas bilateralmente do tipo misto. Na prática clínica, é comum o encontro de atresiaunilateral de coanas em crianças e adolescentes; já a atresia bilateral pode ser potencialmente fatal e geralmente é diagnosticada em neonatos. O objetivo deste relato é demonstrar as características tomográficas dessa doença, incomum na faixa etária do paciente, e fazer uma revisão da literatura dos aspectos clínicos, métodos de diagnóstico e aspectos de imagem encontrados nos pacientes acometidos.

The authors report a case of a 14-year-old child with choanal bilateral imperforation observed in clinical examination. A multidetector computed tomography scan revealed bilateral choanal atresia. No other congenital anomaly was noted. With this relatewe aim to describe the clinic and radiographic aspects of the disease,associated with a review of the iterature.

Atresia de coanas en la edad adulta / Choanal atresia in adults

La atresia de coanas (AC), se define como la falta de conexión entre la cavidad nasal y el tracto aerodigestivo, produciendo obstrucción parcial o total de una o ambas coanas. La etiología más frecuente es congénita, y muchas veces se presenta asociada con otras malformaciones. La causa adquirida es menos frecuente, se han reportado casos en pacientes que han requerido el uso de sondas por vía nasal por periodos prolongados. A continuación se presenta el caso clínico de una paciente de 44 años con el diagnóstico de atresia de coanas adquirida, quien tiene el antecedente de uso prolongado de sonda nasoyeyunal.

Choanal atresia (AC) is defined as the lack of connection between the nasal cavity and the aerodigestive tract, resulting in partial or total obstruction of one or both choanae. The most frequent etiology is congenital, and in many cases it is associated to other malformations. Acquired choanal atresia is less frequent; although cases have been reponed in which patients had required nasal tubing for prolonged periods of time. The clinical case of a 44 year-old female diagnosed with acquired choanal atresia is presented here. The patient had a history of prolonged use of a nasojejunal feeding tube.

Valoración morfológica mediante resonancia magnética de la incontinencia fecal en pacientes con atresia anal corregida / Morphologic evaluation of fecal incontinence by magnetic resonance imaging in patients with corrected anal atresia

Objetivo: Describir los hallazgos obtenidos mediante resonancia magnética (RM) en pacientes con incontinencia fecal previamente intervenidos de anorrectoplastia sagital posterior (ARPSP) por atresia de ano y definir su utilidad en la valoración de su causa. Material y métodos: Se examinaron con RM 0,5T a 12 pacientes, 9 varones y 3 mujeres, a los que previamente se les realizó ARPSP por atresia de ano. El estudio incluía secuencias potenciadas en T1, T2 y DP con planos axiales, sagitales y coronales. Se valoraba el posicionamiento del neorrecto descendido entre los músculos elevadores del ano y complejo esfinteriano y el grado desarrollo de la musculatura pelviana. Resultados: Seis pacientes presentaban un desarrollo adecuado de los músculos elevadores del ano y complejo esfinteriano, con correcto posicionamiento del neorrecto en 5 de ellos y situación excéntrica en 1. En los otros 6 casos se observaron diversos grados de subdesarrollo del complejo muscular estriado, 4 de ellos en grado moderado y en 2, grave. En el último grupo se observaron anomalías congénitas, disráficas espinales y del sistema urogenital. Los planos sagital y coronal potenciados en T1 fueron los más útiles para evaluar la interrelación entre músculos elevadores del ano y complejo esfinteriano, mientras que los planos axiales fueron útiles en la valoración del grado de desarrollo del complejo muscular estriado. Conclusiones: La RM es útil en la evaluación de pacientes con incontinencia fecal tras ARPSP por malformación anorrectal. Una inadecuada posición del neorrecto o hipoplasia del complejo muscular estriado son causas de incontinencia postoperatoria en estos pacientes (AU)

Purpose: To describe the findings obtained with magnetic resonance imaging (MRI) in patients with ano-rectal atresia, after treatment by posterior sagittal anorectoplasty (PSARP), who have fecal incontinence and to describe its usefulness in the evaluation of causes of incontinence. Subject and methods: Twelve patients, 9 men and 3 women, with anorectal atresia were examined with 0.5T MRI after performing PSARP for imperforate anus. The study included T1-weighted, T2-weighted and proton-density, axial, sagittal and coronal planes. The location of descended neorectus and the degree of development of pelvic musculature were evaluated. Results: Normal development of anus levator muscles and sphincterian complex were observed in six patients, with correct situation of neorectus between anus levator muscles and sphincterian complex in five of them and eccentric in the other one. Diverse grades of striate muscular complex underdevelopment were showed in the other six cases, moderate grade in four of them and severe hypoplasia in the other two. Spinal and urogenital congenital anomalies were found in these patients. Sagittal and coronal T1-weighted MR images were the most useful planes in evaluating the relationship between anus levator muscles and sphincterian complex and axial T1-weighted MR images in the evaluation of the level of development of striated muscle complex in the evaluation of patients. Conclusions: MRI is useful in the evaluation of patients with fecal incontinence after performing PSARP for anorectal atresia. Unsuitable neorectus position or striated musce complex hypoplasia are causes of postoperative incontinence in these patients (AU)

Atresia de coana: análise de 16 casos - a experiência do HRAC-USP de 2000 a 2004 / Choanal atresia: analysis of 16 cases - the experience of HRAC-USP from 2000 to 2004

Atresia de coanas é uma patologia rara cuja incidência varia de 1:5.000-8.000 nascidos vivos, sendo mais comum no sexo feminino e associada a outras malformações. FORMA DE ESTUDO: clínico retrospectivo. Quando unilateral, tem seu diagnóstico retardado pela carência de sintomas, porém, quando bilateral, necessita de tratamento imediato devido à insuficiência respiratória e à incapacidade de o recém nascido realizar respiração oral. Neste artigo relatamos a incidência e a experiência do HRAC-USP.

Choanal atresia is a rare disease and the incidence is 1: 5000-8000 newborns alive. It is more comom among female and usually is associated with others malformations. STUDY DESIGN: clinical retrospective. When unilateral its diagnose may be postpone because its symptoms are less life threating. But when bilateral children have important respiratory insuficency. This articles will report incidence and the expirience of HRAC-USP.