30540 Repair choanal atresia; intranasal

Name of the Procedure:

Repair of Choanal Atresia (Intranasal)

• Technical term: Transnasal Endoscopic Repair of Choanal Atresia

Summary

Repair of choanal atresia involves surgically correcting a congenital blockage between the nasal cavity and the throat, typically through the nose using endoscopic techniques.

Purpose

The procedure addresses a congenital condition called choanal atresia, where the back of the nasal passage is blocked. The primary goal is to restore normal nasal airflow, improving breathing and reducing associated complications such as recurrent infections and difficulties with feeding in infants.

Indications

• Symptoms include difficulty breathing through the nose, noisy breathing, recurrent sinus infections, and feeding difficulties in newborns.
• Suitable for patients diagnosed with unilateral or bilateral choanal atresia through imaging studies.

Preparation

• Patients may need to fast for several hours before the procedure.
• Preoperative assessments include nasal endoscopy, CT scans, and sometimes blood tests to ensure the patient is fit for surgery.
• Instructions to adjust or discontinue certain medications, such as blood thinners.

Procedure Description

1. The patient is placed under general anesthesia.
2. A nasal endoscope is inserted into the nasal cavity for visualization.
3. The surgeon removes the bony and/or membranous blockages in the nasal passage.
4. A stent may be placed temporarily to maintain the new opening during healing.
5. The area is irrigated and hemostasis is achieved.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital setting, usually in an operating room equipped for endoscopic surgery.

Personnel

• Surgeons specialized in ENT (Ear, Nose, and Throat) or pediatric otolaryngology.
• Anesthesiologists
• Surgical nurses and supporting staff

Risks and Complications

• Common risks include nasal bleeding, infection, and scarring.
• Rare risks include damage to surrounding structures, such as the nasal septum or turbinates.
• Potential complications may include restenosis (re-blockage) of the nasal passage and the need for further surgery.

Benefits

• Improved nasal breathing.
• Reduction in breathing difficulties and related complications.
• Enhanced quality of life, with benefits often noticeable soon after the procedure.

Recovery

• Postoperative care includes nasal saline irrigations and pain management.
• Regular follow-up appointments are necessary to monitor healing and stent if placed.
• Full recovery typically takes a few weeks, with activity restrictions as advised by the healthcare provider.

Alternatives

• Conservative management such as nasal dilators or CPAP in mild cases.
• Other surgical techniques, like external approaches, are considered if endoscopic repair isn’t viable.
• Each alternative has specific pros and cons, such as varying invasiveness and recovery times.

Patient Experience

• Patients will be under general anesthesia during the procedure and won’t feel anything.
• Post-operative discomfort can include nasal congestion, mild pain managed by medications, and some nasal discharge.
• Most patients can resume normal activities within a few weeks, with specific care instructions to follow for optimal healing.