- Volume - Number
- Published: July 14, 2026
Endoscopic endonasal repair of neonatal bilateral choanal atresia: a case series
António Andrade 1, Pedro Barros 1, Cecília Pereira 2, Gil Coutinho 1, Ricardo Vaz 3, Jorge Spratley 4, Carla Pinto Moura 5
1 Department of Otorhinolaryngology, Unidade Local de Saúde São João, Porto; Unit of Otorhinolaryngology, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; 2 Department of Otorhinolaryngology, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal; 3 Department of Otorhinolaryngology, Unidade Local de Saúde São João, Porto; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto; CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto; NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Porto; Portugal; 4 Department of Otorhinolaryngology, Unidade Local de Saúde São João, Porto; Unit of Otorhinolaryngology, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal; 5 Department of Otorhinolaryngology, Unidade Local de Saúde São João, Porto; Department of Human Genetics, São João Local Health Unit, Porto; Department of Genetics, Faculty of Medicine, University of Porto, Porto; RISE-Health, Department of Pathology, Faculty of Medicine, University of Porto, Porto. Portugal
António Andrade, Pedro Barros, Cecília Pereira, Gil Coutinho, Ricardo Vaz, Jorge Spratley, Carla Pinto Moura
La información completa de afiliaciones y autor de correspondencia está disponible en la versión original en PDF.
*Correspondence: António Andrade, Email not available
Abstract
Introduction and objectives: Bilateral choanal atresia (CA) is a rare neonatal diagnosis that may cause immediate airway compromise and is frequently impacted by associated malformations. We aimed to describe the surgical management and outcomes of infants with bilateral CA treated with an endoscopic endonasal approach. Methods: A retrospective case series included consecutive infants with bilateral CA managed surgically between January 2008 and December 2024. Diagnosis was endoscopically confirmed and imaging was used for operative planning. Surgery followed a standardized endonasal sequence including septal mucosal incision, posterior septectomy, bilateral choanal opening, and mucosal flap repositioning to cover exposed bone. Stents were reserved for significant septal deviation, with planned removal after two to three weeks. Postoperative surveillance included scheduled endoscopic assessments, and balloon dilatation was performed when clinically significant restenosis was detected. Results: Six infants were included (four of whom were female). The age at surgery ranged from five to 107 days (mean 29.5 days). Three patients had a syndromic diagnosis (two with CHARGE syndrome and one with Treacher Collins syndrome). Two infants had esophageal atresia with tracheoesophageal fistula, one requiring jejunostomy. Temporary nasal stenting was used in two cases due to septal deviation. In one infant, an additional posterior membranous obstruction was identified intraoperatively. During follow-up, three patients required balloon dilatation for restenosis. One patient underwent an elective tracheostomy for planned craniofacial management. Discussion: Endoscopic endonasal repair allows airway patency; however, postoperative surveillance is required, together with the management and control of co-existing comorbid conditions. Where syndromes are involved, bilateral CA may include unexpected anatomic abnormalities that should be anticipated during planning.
