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Throat anatomy
Throat anatomy

Choanal atresia
Definition:
Choanal atresia is a congenital narrowing or blockage of the nasal airway by membranous or bony tissue.

Causes, incidence, and risk factors:

The cause of choanal atresia is unknown, but the condition is the most common nasal abnormality seen in the newborn infant. Choanal atresia may be either on one side or on both sides.

The newborn is what is known as an "obligate nose breather," meaning it must breathe through its nose because its oral airway is not yet developed enough to allow for frequent mouth breathing.

In fact, almost the only time an infant does not breathe through its nose is when crying. Choanal atresia blocking both sides of the nose causes acutebreathing problems with cyanosis and breathing failure. Infants with bilateral choanal atresia may need resuscitation at delivery.

Blockage on only one side causes less severe problems. Choanal atresia is generally recognized shortly after birth while the infant is still in the hospital.
Symptoms:
  • present in the newborn infant
  • difficulty breathing following birth unless infant is crying
  • inability to nurse and breathe at same time
  • marked retraction of chest unless breathing through mouth or crying
  • nurse is unable to pass a catheter through each side of the nose into the throat
Signs and tests:
Physical examination may show an obstruction of the nose. Inability to pass a catheter through one or both side(s) of the nose into the back of the throat strongly suggests of a nasal obstruction. Instilling an x-ray dye in the nasal cavity and taking an x-ray can also be used to diagnose choanal atresia.
Treatment:
Immediate concerns include resuscitation of the baby if necessary. An airway may need to be placed so that the infant can breathe.

An infant can learn to mouth breathe, which can delay the need for immediate surgery.

Surgery to remove the obstruction is curative. It may be delayed if infant can tolerate mouth breathing. In some cases, a small plastic tube can be placed through the membrane causing the obstruction, allowing for delayed surgical repair at the age of about 5 years old, when the child is larger and surgery can be performed more easily. The operation involves an incision on the inside of the roof of the mouth, which allows for access to the blocked nasal airway.
Expectations (prognosis):
Full recovery is expected.
Complications:
Calling your health care provider:
Choanal atresia, especially when it affects both sides, is generally diagnosed shortly after birth while the infant is still in the hospital. One-sided atresia may be relatively symptom-free, and these infants may be sent home without diagnosis. If your infant exhibits any of the problems listed here, consult your health care provider.
Prevention:
Because the cause is unknown, prevention is unknown.
Review Date: 2/23/2002
Reviewed By: Robert W. O'Rourke, M.D., Department of Minimally Invasive Surgery, Legacy Health System, Portland, OR. Review provided by VeriMed Healthcare Network.
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