Choanal atresia

As choanal atresia ( atresia choanae also ) of congenital membranous or bony closure of the posterior nostril is called. In ten percent of those affected, this closure is membranous, bony at 90 percent. The posterior nares, as paired posterior nostril, forming the transition from the nasal cavity into the pharynx. Atresia comes from the Greek ἄτρητος atretos in the meaning " without opening ". The incomplete closure called Choanalstenose. There are the rare front Nasenatresien that are 1 to 2 cm away from the nostril. The mean atresia are usually acquired as a result of chronic turbinate inflammation. The partial closure is called synechia. Congenital choanal atresia is a rare malformation, which at 1 / 5000-10000 births occurs. The one-sided Choanenverschluss is about five times more often than the two-sided.

Cause

The posterior nares occur between the third and seventh week of embryonic development as an opening between nasal cavity and pharynx by the membrana oro - nasal, a Epithelduplikatur between olfactory pit and oral cavity roof tear. If at this time during embryonic development a fault occurs, the oro - nasal or bucconasale diaphragm ruptures impossible or incomplete one, has an incomplete (stenosis ) or complete closure ( atresia ) result. The bony closure caused by a scattered bone formation from the mesoblast.

Symptoms

In the bilateral choanal atresia in the newborn, there is a lack of nasal breathing and shortness of breath while drinking, so a food intake greatly hindered or impossible. The respiratory disorder can lead to respiratory failure and thereby threaten the life of the newborn. The newborn baby is cyanotic, his heartbeat is slower and it vomits. Since the cyanosis under exertion ( crying ) is less pronounced than at rest (due to it expiring mouth breathing ), is also spoken by a paradoxical cyanosis. Infants are characterized by a physiological laryngeal high level until about the sixth week of life nose breathers and can only with difficulty breathing through the mouth.

A unilateral Choanenverschluss makes often only noticeable over time, on the affected side occurs tough, purulent mucus from the nasal opening. The turbinates are livid discolored.

Diagnostics

In cases of suspected choanal atresia can be checked for throat with a soft catheter patency. Serves the same purpose an air injection with a balloon. Further diagnostic steps are to investigate the nasal and the nasal endoscopy. Depending on the need for clarification are a CT or MRI use. Choanalatresien occur 10% to 50 % with other malformations.

Therapy

The dual-sided Choanalverschluss is an emergency. Light membranous closures can be sometimes pierced with the nasal catheter. About an endotracheal tube breathing must be secured and guaranteed by a special diet. A recourse to the surgeon is immediately necessary. The perforation of the atretic plate with inserting a placeholder to avoid a re- closure is to take place in the first days of life. The definitive operation can then take place within the first few weeks to months of life. There are two surgical access routes, which is a through the nose, the other from the throat. Are necessary after surgery splints and measures for keeping the airways by the parents. Because of the danger of swallowing disorders, a long-term care is required. For single-sided Choanalverschluss the operation can be done in the school age child.

184712
de