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Congenital bilateral choanal atresia: an endoscopic approach with multi-flaps supported by neuronavigated CT
  1. Cosimo Galletti1,
  2. Francesco Freni1,
  3. Francesco Ciodaro2 and
  4. Bruno Galletti1
  1. 1Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
  2. 2Universita degli Studi di Messina, Messina, Italy
  1. Correspondence to Dr Cosimo Galletti; cosimogalletti92{at}


We present a case of a 2-month-old patient with CHARGE syndrome, cerebral haemorrhage and bilateral congenital choanal atresia (CCA). He was admitted to our otorhinolaryngology unit to solve his congenital bilateral choanal atresia proposing a transnasal endoscopic surgery. A study of CT of the skull showed that the air column was interrupted on both sides of nasal cavities; a nasal endoscopy with neonatology flexible optics showed the presence of a membrane and bony structure obstructing the passage into the nasopharynx. Preoperative brain magnetic resonance (MRN) has been made. We decided to carry out a transnasal endoscopic neuronavigation approach with multi-flaps without stenting apposition to solve the CCA, using a 0° 2.7-millimetre rigid endoscopic and Skeeter-type drill with a 2.3-millimetre microblade cutter. Postoperative nasal care was essential to avoid recurrences. Endoscopic follow-up was performed; a large uni-neochoane was residual at 3 months, all raw surfaces were covered by multiple mucosal flaps welded with fibrin.

  • ear
  • nose and throat/otolaryngology
  • otolaryngology / ENT
  • head and neck surgery
  • paediatric surgery

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  • Contributors BG: treated the patient. CG: is the corresponding author, prepared the manuscript, did bibliography research and English translation, and developed the concept and design of the study. FC: the ENT specialist who first saw the patient and suspected congenital bilateral choanal atresia, and performed follow-up examinations. FF: critically revised the manuscript and gave the approval of the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.