Transnasal endoscopic repair of choanal atresia: Why stent?

OBJECTIVE: To analyze the outcome of transnasal endoscopic repair of choanal atresia in children without stenting. DESIGN: Retrospective review. SETTING: Academic pediatric referral center. PATIENTS: Thirteen children ages 2 days to 13 years old (mean 45 months) who presented with unilateral (8) or bilateral (5) choanal atresia and underwent transnasal endoscopic surgery between January 1997 and May 2002. No stents were used. All patients received combinations of oral steroids, topical nasal steroids, and oral antibiotics. Patency was defined as less than 50% restenosis. RESULTS: The 4 patients who underwent office serial examination alone after surgery remained patent. Seven of the 9 patients who underwent reexamination under general anesthesia had varying amounts of emerging granulation tissue or minor synechia formation that resolved with microdebrider excision. All serial office endoscopies demonstrated no restenoses. No office dilations were performed. There were no long-term complications. One patient (2 days old) who underwent tracheoesophageal fistula repair and bilateral choanal atresia repair on the same day required a blood transfusion. Both patients with tracheostomies were decannulated. CONCLUSIONS: Transnasal endoscopic repair of choanal atresia, both unilateral and bilateral, is safe, and is effective without stenting. Postoperative failure of endoscopic approaches may be a result of prolonged mucosal trauma from stenting rather than any deficiency inherent in the surgical technique. Adjuctive therapy may not offer any advantage in promoting patency.