Main theme: Rhinology
Introduction: Unilateral choanal atresia (UCA) is a rare congenital nasal anomaly presenting with unilateral nasal obstruction and discharge1,2. Unlike bilateral choanal atresia, presentation may be delayed and surgery is usually elective2. Re-stenosis and revision surgery remain important challenges3. This study evaluated UCA outcomes at a tertiary paediatric centre, focusing on age at surgery and operative technique.
Methods: Retrospective case-note review identified paediatric patients undergoing surgical management of UCA between January 2015 and March 2026. Data included demographics, co-morbidities, atresia type, surgical approach, number of procedures, inter-procedure intervals, and restenosis rates. Mann-Whitney U, Fisher's exact, and Spearman correlation tests were used, with Poisson regression to assess the independent effect of surgical approach on procedure count controlling for age.
Results: Twenty-eight patients underwent surgery; 60.7% (n=17) were female and median age at first surgery was 11.4 months. Co-morbidities were present in 50.0% (n=14), most commonly cardiac and airway anomalies. Restenosis occurred in 60.0% (n=15). Younger age correlated significantly with more procedures (Spearman r = −0.51, p = 0.006). Flap techniques were associated with fewer procedures (median 1 vs 3; p = 0.007) and lower restenosis (37.5% vs 70.6%). Flap technique remained independently associated with fewer procedures after controlling for age (IRR 0.42, 95% CI 0.20–0.91; p = 0.027).
Conclusion: Younger age at first surgery and transoral dilatation were associated with greater procedural burden and higher restenosis rates. Where anatomically feasible, endoscopic repair may improve durability and reduce revision surgery. Prospective multicentre studies are required to validate these findings.
References
1. Case AP, Mitchell LE. Prevalence and patterns of choanal atresia and choanal stenosis among pregnancies in Texas, 1999-2004. Am J Med Genet A 2011;155:786–91. https://doi.org/10.1002/AJMG.A.33882;SUBPAGE:STRING:ACCESS.
2. Harris J, Robert E, Källén B. Epidemiology of choanal atresia with special reference to the CHARGE association. Pediatrics 1997;99:363–7. https://doi.org/10.1542/PEDS.99.3.363.
3. Kim H, Park JH, Chung H, Han DH, Kim DY, Lee CH, et al. Clinical features and surgical outcomes of congenital choanal atresia: Factors influencing success from 20-year review in an institute. American Journal of Otolaryngology – Head and Neck Medicine and Surgery 2012;33:308–12. https://doi.org/10.1016/j.amjoto.2011.08.010.