A Case Report of Late Diagnosis of Bilateral Choanal Atresia

Choanal atresia (CA) is a congenital closure of the posterior nasal choanae. The closure can be unilateral or bilateral. Since the first report of CA, there have been controversies regarding its pathogenesis and the effectiveness of surgical approaches. The few cases reported in the literature were not diagnosed immediately after birth. We present a case of delayed presentation of CA. The patient was born pre-teen (35 weeks) by cesarean section. He was diagnosed with bilateral CA by history, physical examination, endoscopic and radiological images at five months of age. Congenital bilateral CA is rarely discovered in neonatal patients after one week of age, therefore few such cases have been reported in the literature. Nasal endoscopy and computed tomography help diagnose CA before planning surgery. Several surgical approaches for repairing congenital CA have been reported, including the transnasal and transpalatal routes. Endoscopic transnasal choanoplasty is currently the preferred approach. Though CA is a rare congenital malformation, there are cases with a delayed diagnoses reported in the literature. These findings raise the question of whether all newborns are obligate nasal breathers. Although rare, bilateral CA should be suspected in infants who exhibit difficulty with feeding and bilateral nasal obstruction, as in such cases it is impossible to feed and breathe simultaneously.