Introduction
Unilateral choanal atresia (UCA) is a congenital posterior nasal obstruction with an incidence of 1 in 5,000–8,000 live births. Despite being twice as common as bilateral disease, optimal surgical technique and outcomes remain poorly defined. This systematic review and meta-analysis evaluated the effectiveness and safety of surgical repair for UCA.
Methods
A PRISMA-compliant systematic review was registered on PROSPERO (CRD420261336288). Multiple databases were searched for studies published between 2000 and 2026. Eligible studies included paediatric patients (0–18 years) with UCA undergoing primary surgical repair; revision surgeries were excluded. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) and meta-analysis of pooled restenosis rates was performed.
Results
Twenty-nine studies encompassing 709 UCA patients from 18 countries were included. Transnasal endoscopic choanoplasty was the predominant approach; stents were used in 18 studies (62.1%) and mitomycin C in 13 (44.8%). The pooled restenosis rate was 18.7% (range 0–72%). Mucosal flaps were employed in 13 studies (44.8%), with a lower mean restenosis rate than non-flap studies (9.9% vs. 26.2%), though not statistically significant (p = 0.207). Age at surgery did not correlate with restenosis (Spearman ρ = −0.26, p = 0.254). NOS assessment rated 14 studies (48.3%) as good quality and 15 (51.7%) as fair; none were poor.
Conclusions
UCA repair carries a restenosis rate of 18.7%. Mucosal flap use was associated with a clinically meaningful reduction in restenosis, and age at surgery did not predict outcome. Prospective comparative studies with standardised outcome reporting are needed to define optimal management.
References
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