António Andrade, 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
Pedro Barros, 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
Cecília Pereira, Department of Otorhinolaryngology, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
Gil Coutinho, 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
Ricardo Vaz, 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
Jorge Spratley, 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
Carla Pinto Moura, 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
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.
Keywords: Choanal atresia. Nasal surgical procedures. Infant. Newborn. CHARGE Syndrome. Mandibulofacial dysostosis.
