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.
Protection