Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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March 16, 2017
Unilateral Membranous Choanal Atresia
- Background:
- Embryological failure of mesodermal plate apoptosis between the stomodeum and ectoderm
- Incidence of 1 in 8000 live births
- 2 types—membranous and osseous
- Clinical Presentation:
- Bilateral atresia presents with neonatal respiratory distress.
- Unilateral can be either asymptomatic or present late with rhinorrhea or infection.
- Key Diagnostic Features:
- Axial posterior nasal narrowing (≤3mm) at level of pterygoid plates, thickening and deviation of vomer
- Differential Diagnoses:
- Pyriform aperture stenosis: medial deviation of the maxillary spines and soft tissue spanning the nasal nares
- Nasolacrimal duct mucocele: osseous nasolacrimal canal enlargement containing soft tissue density; may extend into nasal cavity
- Mucoid impaction: soft tissue density within the nasal cavity without bony anomalies
- Treatment:
- Neonates require a secured airway.
- Thin membranes are perforated nasoendoscopically.
- Osseous atresia are addressed by choanal reconstruction and temporary stent placement to ensure patency.
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