Choanal atresia discussion must be divided into the type of atresia (unilateral or bilateral). Bilateral atresia means there is no opening behind either nasal cavity and thus, a newborn baby would not be able to breathe at all from the nose. Because newborn babies know only to breathe through their nose, this causes a life-threatening situation. For this reason, neonates with bilateral choanal atresia require surgery in the first few weeks of life. The surgery could be a choanal atresia repair or a tracheostomy. In a child without other major medical problems we like to attempt a choanal atresia repair in order to avoid a tracheostomy. Occasionally, children with other medical issues do go on to require a tracheostomy even if the atresia repair is successful. The repair can usually be performed through the nose with very small telescopes and small instruments. Most infants require plastic stents to be placed for 1-4 weeks following surgery to keep the repair sites open. Most children require further dilations at some point to keep the nasal passages open.
Children with unilateral or one-sided atresia may be diagnosed at birth or at a later date. The symptoms are drainage from the nasal cavity that has the atresia. Children with a unilateral condition do not usually have death spells or significant problems and thus, do not require repair as an infant. We generally repair these children between ages 2 and 5 years. We generally can perform the repair through an endoscopic technique (through the nose without any external incisions).