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Laryngorhinootologie 2018; 97(04): 264-268
DOI: 10.1055/s-0044-101464
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Die endonasale endoskopische Resektion von Choanalatresien – wie groß ist der Langzeiterfolg?

Endonasal endoscopic surgery of choanal atresia – long term results
Laura Holtmann
1   Universitätsklinikum Essen Klinik für Hals-Nasen-Ohrenheilkunde
,
Kerstin Stähr
1   Universitätsklinikum Essen Klinik für Hals-Nasen-Ohrenheilkunde
,
Julian Kirchner
2   Universitätsklinikum Düsseldorf Radiologie
,
Stephan Lang
3   Uniklinikum Essen Otorhinolaryngology
,
Stefan Mattheis
4   Universitätsklinikum Essen Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie
› Author Affiliations
Further Information

Publication History

01/02/2018

01/16/2018

Publication Date:
08 February 2018 (online)

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Zusammenfassung

Einleitung Die Choanalatresie gehört zur Gruppe der seltenen Fehlbildungen. Sie stellt bei beidseitigem Auftreten einen akut lebensbedrohlichen Notfall dar, da Neugeborene obligate Nasenatmer sind. Die endoskopische Resektion ist eine etablierte Therapie, die Operationstechnik ist bisher jedoch nicht standardisiert.

Methodik Die endonasal endoskopische Resektion von kongenitalen Choanalatresien bei 11 Kindern wurde retrospektiv in einem Nachbeobachtungszeitraum von 9 bis 87 Monaten analysiert. Vier Kinder wiesen eine bilaterale, sieben eine unilaterale Atresie auf. Neben der endoskopischen Resektion der Choanalatresie erfolgten die Erweiterung der Choane durch endoskopisches Abtragen des Knochens Richtung Schädelbasis und das Abtragen der hinteren Septumkante. Das intraoperative Handling, intra- und postoperative Komplikationen und die Rezidivrate im Verlauf wurden ermittelt. Eltern bzw. Patienten wurden zur subjektiven Einschätzung der Nasenatmung befragt.

Ergebnisse Intraoperative Komplikationen wurden keine beobachtet. Drei Frühgeborene wurden innerhalb der ersten Lebenswoche bei einem durchschnittlichen Geburtsgewicht von 2540 g operiert. Postoperativ kam es zweimal zu Schmierblutungen. Die langfristige Rezidivfreiheit lag bei 73 % (unilateral) bzw. 100 % (bilateral).

Schlussfolgerungen Die endonasale endoskopische Resektion von Choanalatresien mit Erweiterung der Choane Richtung Schädelbasis, Reduktion des Nasenbodens und Abtragen der hinteren Septumanteile stellt eine schonende und erfolgreiche Therapieoption dar.

Abstract

Introduction Choanal atresia is a rare abnormality. As neonates depend on transnasal respiration, bilateral choanal atresia causes an acute emergency. Transnasal endoscopic resection of congenital choanal atresia is a well-established therapy. However, the surgical technique has not yet been standardized.

Methods A retrospective chart review was performed with a follow-up examination between 9 to 87 months after surgery. 11 patients (7 with unilateral atresia, 4 with bilateral atresia) were included. The choana was opened and enlarged endoscopically by resection of the posterior septal wall and bony reduction up to skull base and nasal floor. Intraoperative handling, intra- and postoperative complications, restenosis and adequate respiratory function were assessed.

Results No intraoperative complications could be observed. Three premature babies underwent surgical intervention within their first postnatal week with an average weight of 2540 g. 2/11 patients suffered from a minor episode of epistaxis as a postoperative complication. Long-term success without restenosis was 73 % (for unilateral atresia) and 100 % for bilateral (atresia).

Conclusions Choosing an endonasal endoscopic approach to resect choanal atresia via resection of the posterior septal wall and circular bony reduction is a successful therapy with low morbidity.

Schlüsselwörter

Choanalatresie - Endoskopische Resektion - Pädiatrische HNO-Heilkunde - Operationstechnik - CHARGE-Syndrom

Key words

choanal atresia - endoscopic resection - pediatric otorhinolaryngology
 

  • Literatur

  • 1 Case AP, Mitchell LE. Prevalence and patterns of choanal atresia and choanal stenosis among pregnancies in Texas, 1999–2004. American journal of medical genetics Part A 2011; 155a: 786-791
    PubMedGoogle Scholar
  • 2 Harris J, Robert E, Kallen B. Epidemiology of choanal atresia with special reference to the CHARGE association. Pediatrics 1997; 99: 363-367
    CrossrefPubMedGoogle Scholar
  • 3 Harner SG, McDonald TJ, Reese DF. The anatomy of congenital choanal atresia. Otolaryngology-head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery 1981; 89: 7-9
    PubMedGoogle Scholar
  • 4 Hengerer AS, Strome M. Choanal atresia: a new embryologic theory and its influence on surgical management. The Laryngoscope 1982; 92: 913-921
    PubMedGoogle Scholar
  • 5 Hengerer AS, Brickman TM, Jeyakumar A. Choanal atresia: embryologic analysis and evolution of treatment, a 30-year experience. The Laryngoscope 2008; 118: 862-866
    CrossrefPubMedGoogle Scholar
  • 6 Llorente JL, Lopez F, Morato M. et al. Endoscopic treatment of choanal atresia. Acta otorrinolaringologica espanola 2013; 64: 389-395
    PubMedGoogle Scholar
  • 7 Kwong KM. Current Updates on Choanal Atresia. Frontiers in Pediatrics 2015; 3: 52
    PubMedGoogle Scholar
  • 8 Verma RK, Lokesh P, Panda NK. Congenital bilateral adult choanal atresia undiagnosed until the second decade: How we did it. Allergy & rhinology (Providence, RI) 2016; 7: 82-84
    CrossrefPubMedGoogle Scholar
  • 9 Brown OE, Pownell P, Manning SC. Choanal atresia: a new anatomic classification and clinical management applications. The Laryngoscope 1996; 106: 97-101
    CrossrefPubMedGoogle Scholar
  • 10 Slovis TL, Renfro B, Watts FB. et al. Choanal atresia: precise CT evaluation. Radiology 1985; 155: 345-348
    CrossrefPubMedGoogle Scholar
  • 11 Emmert C. Stenochorie und Atresie der Choannen, Lehrbuch der Speciellen Chirurgie. Stuttgart 1854; 2: 535-538
    PubMedGoogle Scholar
  • 12 Owens H. Observations in treating seven cases of choanal atresia by the transpalatine approach. The Laryngoscope 1951; 61: 304-319
    PubMedGoogle Scholar
  • 13 Stankiewicz JA. The endoscopic repair of choanal atresia. Otolaryngology-head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1990; 103: 931-937
    PubMedGoogle Scholar
  • 14 Eladl HM, Khafagy YW. Endoscopic bilateral congenital choanal atresia repair of 112 cases, evolving concept and technical experience. International journal of pediatric otorhinolaryngology 2016; 85: 40-45
    CrossrefPubMedGoogle Scholar
  • 15 Riepl R, Scheithauer M, Hoffmann TK. et al. Transnasal endoscopic treatment of bilateral choanal atresia in newborns using balloon dilatation: own results and review of literature. International journal of pediatric otorhinolaryngology 2014; 78: 459-464
    CrossrefPubMedGoogle Scholar
  • 16 El-Anwar MW, Nofal AA, El-Ahl MA. Endoscopic repair of bilateral choanal atresia, starting with vomer resection: Evaluation study. American journal of rhinology & allergy 2016; 30: 95-99
    CrossrefPubMedGoogle Scholar
  • 17 Ibrahim AA, Magdy EA, Hassab MH. Endoscopic choanoplasty without stenting for congenital choanal atresia repair. International journal of pediatric otorhinolaryngology 2010; 74: 144-150
    CrossrefPubMedGoogle Scholar
  • 18 Newman JR, Harmon P, Shirley WP. et al. Operative management of choanal atresia: a 15-year experience. JAMA otolaryngology-head & neck surgery 2013; 139: 71-75
    CrossrefPubMedGoogle Scholar
  • 19 Kopacheva-Barsova G, Nikolovski N. Justification for Rhinoseptoplasty in Children – Our 10 Years Overview. Open access Macedonian journal of medical sciences 2016; 4: 397-403
    CrossrefPubMedGoogle Scholar
  • 20 Wormald PJ, Zhao YC, Valdes CJ. et al. The endoscopic transseptal approach for choanal atresia repair. International forum of allergy & rhinology 2016; 6: 654-660
    CrossrefPubMedGoogle Scholar
  • 21 Velegrakis S, Mantsopoulos K, Iro H. et al. Long-term outcomes of endonasal surgery for choanal atresia: 28 years experience in an academic medical centre. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2013; 270: 113-116
    PubMedGoogle Scholar
  • 22 Teissier N, Kaguelidou F, Couloigner V. et al. Predictive factors for success after transnasal endoscopic treatment of choanal atresia. Archives of otolaryngology – head & neck surgery 2008; 134: 57-61
    CrossrefPubMedGoogle Scholar
  • 23 Cedin AC, Atallah AN, Andriolo RB. et al. Surgery for congenital choanal atresia. The Cochrane database of systematic reviews. 2012 DOI: 10.1002/14651858.CD008993.pub2: Cd008993
    PubMedGoogle Scholar
  • 24 Strychowsky JE, Kawai K, Moritz E. et al. To stent or not to stent? A meta-analysis of endonasal congenital bilateral choanal atresia repair. The Laryngoscope 2016; 126: 218-227
    CrossrefPubMedGoogle Scholar
  • 25 Josephson GD, Vickery CL, Giles WC. et al. Transnasal endoscopic repair of congenital choanal atresia: long-term results. Archives of otolaryngology – Head & Neck Surgery 1998; 124: 537-540
    PubMedGoogle Scholar
  • 26 Schoem SR. Transnasal endoscopic repair of choanal atresia: why stent?. Otolaryngology –head and neck surgery: official journal of American Academy of Otolaryngology – Head and Neck Surgery 2004; 131: 362-366
    PubMedGoogle Scholar
  • 27 Van Den Abbeele T, Francois M, Narcy P. Transnasal endoscopic treatment of choanal atresia without prolonged stenting. Archives of Otolaryngology – Head & Neck Surgery 2002; 128: 936-940
    CrossrefPubMedGoogle Scholar
  • 28 Durmaz A, Tosun F, Yldrm N. et al. Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. The Journal of craniofacial surgery 2008; 19: 1270-1274
    CrossrefPubMedGoogle Scholar