Is isolated bilateral choanal atresia a real emergency? Report of two case !

Clinical scenarios:  

Case 1

 A sixty-year-old  female presented to our Ear, Nose and Throat unit with a complaint of hoarseness  of 6 weeks duration.  Clinically she was fairly obese with short and thick neck and no palpable mass or neck nodes. Naso-laryngoscopy, with astonishment, showed bilateral choanal atresia  (BCA), prompting us to perform oro-laryngoscopic examination, revealing right vocal cord palsy.

Fig.1 First Patient : CT scan of Para-nasal sinuses showing Bilateral  counal atresia 

      CT of paranasal sinuses (Figure 1) and neck confirmed BCA . Although, the patient could not breathe through her nose for as long as she could remember, it never bothered her, therefore, she never sought medical attention. It has been part of her normal life. 

Case 2

     A 24-year-old male presented with bilateral chronic nasal blockage for as long as he remembers during which he was a mouth breather. This was associated with recurrent thick nasal discharge. He denied any history of nasal trauma or surgery. There was no other associated complaint. His other sibling had a diagnosis of unilateral choanal atresia.

Fig.2 Second patient showing Bilateral counal atresia 

           Endoscopic nasal examination showed BCA with inability to visualise the postnasal space. Other ENT examination was essentially normal and there were no signs of other congenital anomalies.

        The diagnosis of bilateral mixed CA (Figure 2) was confirmed by CT scan. The patient underwent transnasal drilling of the bony atretic plate without stenting. He had an uneventful post-operative recovery. One year follow-up showed no evidence of recurrence.

  Teaching message :

Choanal atresia (CA) is not an uncommon congenital malformation.It is caused by failure of buccopharyngeal membrane to break in intrauterine life. It may be unilateral or bilateral, membranous or bony. CA was first described in 1755 by Roederer

The presentation here clearly showed that there is no fatal outcome of isolated BCA. The explanation given by Baker et al, , of new-borns with BCA to quickly learn and adopt mouth breathing is sound and can be considered an acceptable theory. This may explain the survival of our two adult cases, 

For further Reading click the Link: Choanal Atresia

  

  This case was contributed by: 

    Dr. Sami A Al kindy FRCSEd (ORL-HNS), DLO (ENG)

     Consultant ENT surgeon & 

     Associate Professor  College of Medicine 

     Taif University KSA