SYMPTOMS:
- stretor
- mouth breathing
- feeding difficulty
- sleep disturbances
- rhinorrhoea
- failure to thrive
ASCERTAIN WHETHER THESE SYMPTOMS ARE:
- unilateral or bilateral
- complete or partial
- intermittent or constant
- acute or chronic
- gradual or sudden onset
- present since birth or developed subsequently
CAUSES OF NASAL OBSTRUCTION
- CONGENITAL:
- Anatomical/skeletal abnormalities: choanal atresia
- pyriform aperture stenosis
- nasal agenesis
- craniosynostosis sundromes
- “cleft palate” nose
- Nasal cysts: dermoid
- nasoalveolar
- nasolacrimal
- dentigenerous
- mucous
- pharyngeal bursa (Thornwaldt cyst)
- Nasal masses: meningo/encephalocele
- glioma
- hamartoma
- chordoma
- teratoma
2. ACQUIRED:
- Structural: osteocartilagenous nasal deformity
- foreign body
- Inflammatory: Infective
- ARS/ polyposis
- Pysiological: neonatal or pubertal rhinitis
- Tumours: Angiofibroma
- ONA
- Rhabdomyosarcoma
- NPC
- Haemangioma
- Fibro-osseous disease
3. SYSTEMIC DISEASE CAUSING NASAL OBSTRUCTION
- Cystic fibrosis
- Ciliary dyskinesia
- Immune deficiency
- Sarcoidosis
- Wegener’s granulomatosis
CHOANAL ATRESIA
- It is the complete obstruction of the posterior nasal opening on one or both sides.
- Rare cndition
- Bony or Membranous or Mixed
- Occurs due to persistence of the nasobuccal membrane
- May be isolated or one of the feature of CHARGE syndrome.
- Presentation:
- As an acute respiratory emergency in newborn as they are obligate nasal breathers and oral airway ieves the distress.
- Classical blue spells relieved by crying.
- Unilateral problems often come to light in an older child with a persistent profuse one-sided nasal discharge in whom there is no history of foreign body insertion.
- On examination using a metal spatula just below the nasal aperture: mist is absent
- Inability to pass the nasal catheter
INVESTIGATIONS
- Flexible nasoendoscopy
- CT scanning after nasal suction clearance and application of 0.5 % ephidrine drops 30 minutes previously.
- Additional investigations:
- cardiac echo
- renal ultrasound
- ophthalmological review
- audiological review
TREATMENT:
- Always surgical removal of atretic plate and posterior aspect of vomer with or without stenting
- Approaches are:
- Transpalatal
- Transnasal using 120 degree endoscope
- Role f MMC (mitomycin C): still being clarified and usually used during stent removal and subsequent dilatations
- KTP laser for removal of granulation tissue postoperatively.
PYRIFORM APERTURE STENOSIS
- The pyriform aperture is the narrowest part of nasal airway.
- Ususally due to bony overgrowth of the nasal process of the maxilla.
- Symptoms are similar tobilateral choanal atresia, epiphora due to nasolacrimal duct (NLD) obstruction.
- Endoscopy: Not done
- CT scan: confirmatory and shows the “Mega-incisor”, a single central incisor. This condition may be associated with holoprosencephaly.
- Treatment:
- Conservative use of nasal topical medication
- Severe obstruction needs removal of abnormal bone by drilling using trannasal approach with an alar-releasing incision or sublabial incision followed by lifting of mucosa. Nasal stents are then placed for several weeks.
CONGENITAL NASAL CYSTS
