Birth Defects Respiratory Choanal Atresia

Choanal atresia is a congenital defect affecting the respiratory system. The condition involves a narrowing or blockage of the nasal passages, causing difficulty with breathing. Infants normally breathe through their noses for the first several weeks of life; mouth breathing occurs primarily during crying. As a result, choanal atresia presents a significant respiratory problem for infants.

Choanal Atresia Types

The cause of choanal atresia is not known. Some specialists believe that the membrane that separates the oral and nasal cavities during fetal development remains after birth in cases of choanal atresia. The membrane prevents air from passing through the nose.

Unilateral choanal atresia affects only one nasal passage, whereas bilateral choanal atresia affects both. The severity depends on whether one or both nasal passages are affected, as well as the degree of obstruction.

Unilateral choanal atresia may not be noted immediately at birth, as the child is still able to breathe nasally. However, bilateral choanal atresia is usually diagnosed at birth, as affected infants often experience respiratory distress.

A choanal atresia diagnosis can be confirmed when a catheter that is passed through the nostril or nostrils is met with an obstruction. The effects of choanal atresia can be observed at home by placing a small mirror under the infant’s nose, and looking for patterns of condensation indicative of nasal breathing.

An incomplete obstruction is sometimes called choanal stenosis. Generally, stenosis refers to a partial obstruction of a passage or opening, whereas atresia refers to a complete obstruction. However, the term choanal atresia is often used to refer to any congenital obstruction of the nasal passages.

Effects of Choanal Atresia

Choanal atresia always affects respiration to some degree. Bilateral choanal atresia can lead to cyanosis (a bluish tint to the skin from oxygen deprivation), or respiratory failure. The chest may retract as the child breathes through her mouth or cries.

Children with bilateral choanal atresia also have difficulty nursing and breathing at the same time. In addition, they may aspirate food or liquid into the lungs while trying to coordinate feeding and respiration.

Choanal Atresia Treatment

Initially, a tube may have to be inserted through the mouth (intubation) or through the front of the neck into the trachea (tracheostomy) to help the infant breathe. Eventually, surgery may be required to remove the obstruction.

Surgery may be delayed if the infant is successfully breathing by mouth. If the infant can breathe through the mouth, waiting to perform surgery may be beneficial, as the risks of anesthesia and surgery are lower once the infant has had an opportunity to grow and develop.

Post-surgical care can be complex and difficult. Tubes are placed in the nasal passages after surgery, and these must be constantly cleaned, monitored and maintained. Care of the surgical site is essential for maintaining the newly opened airway.


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