SURGICAL MANAGEMENT OF CHOANAL RESTENOSIS AND REHABILITATION OF CHILDREN OF THE FIRST YEAR OF LIFE AFTER TRACHEOSTOMY AND CHOANOPLASTY

Abstract

Among congenital malformations of face and skull in children, congenital choanal atresia is most often treated surgically. Despite of the achievements in surgical treatment of choanal atresia, some authors pay attention to a large number of unsatisfactory functional results associated with scarring and postoperative stenosing. Purpose. To evaluate outcomes after endoscopic choanal atresia repair with a vascularized mucosal flap using fibrin glue without stents in infants. Materials and methods. 21 patients, aged 23 days -1 year, with bilateral choanal atresia, had choanoplasty by the traditional technique with stents. Nine children were made tracheostomy before choanoplasty at birth due to indications. All children had endoscopic endonasal choanal reconstruction by the technique developed by the authors, when a posterior septal flaps secured with fibrin glue without stents or tamponage is used. All patients were divided into two groups: Group 1 - 12 children without tracheostomy after primary choanoplasty (57.2%); Group 2 – 9 children with tracheostomy after primary choanoplasty (42.8%). Results. In Group 1, children resumed independent nasal breathing already in ICU immediately after the surgery and did not require mechanical ventilation; and all of them started to eat independently within 10–14 days. Patients from Group 2, after choanal atresia repair, required a rehabilitation period for transition to the independent nasal breathing so as to adapt to breathing without a tracheostomy tube; 6 children (66.6%) started natural feeding. Endoscopic examination of the nasal cavity in 3 and 6 months in both groups showed complete epithelization of wound surface in the neochoana site. No restenosis was revealed. Conclusion. The endoscopic approach, developed by the authors, including a vascularized mucosal flap without stenting and with fibrin glue, seems to be a method of choice for reconstructive choanoplasty, for it has the lowest possible risk of recurrence and shorter postoperative period, as well as much better quality of life.