Late Diagnosis of Bilateral Choanal Atresia: A Case Report
Introduction: Choanal atresia occurs when the posterior nasal cavity fails to communicate with the nasopharynx.. This anomaly has a reported incidence ranging from 1 in 5,000 to 1 in 8,000 live births. The clinical presentation of bilateral cases present as newborns with cyanotic events. A variant occurs later in life with mouth breathing, recurrent sinusitis, chronic rhinorrhea, otitis media, and defects of speech. The diagnosis is made clinically by failure to pass a catheter through the nose into the nasopharynx. Computed tomography (CT) is used to confirm the diagnosis and reveal the nature and thickness of the atresia. Bilateral atresia requires an initial intervention to establish an oropharyngeal or orotracheal airway before surgery.
Objectives: The study aims to report a case of late diagnosis of bilateral choanal atresia.
Report: A 3-year-old patient (V. G. L. S.), presented mouth breathing since birth, snoring, respiratory distress, and nasally voice. The patient had respiratory distress upon birth requiring oxygen therapy. Physical examination showed excavated palate and a lot of secretion in the nose. CT of the sinuses showed bilateral choanal imperforation. Patient underwent surgery with transeptal technique with rotation flaps. The child no longer has nasal obstruction and is being kept for monitoring.
Conclusion: Although rare bilateral choanal atresia should be suspected in cases where the progression of the catheter in the nasopharynx of neonates is difficult. This patient had a late diagnosis and probably survived because of an early institution of oral breathing. However, cases like this, should be addressed surgically as early as possible because of the potential fatality of the disease.