Choanal Atresia Workup

  • Author: Ted L Tewfik, MD, FRCSC; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jul 22, 2011
 

Imaging Studies

Rhinography is a procedure that involves the administration of radiopaque dye into the nasal cavity as illustrated in the image below.

Choanal atresia. Rhinogram demonstrating blockage Choanal atresia. Rhinogram demonstrating blockage of radiopaque dye at the posterior choanae. From T.L. Tewfik and V.M. Der Kaloustian, with permission.

CT scanning is the radiographic procedure of choice in the evaluation of choanal atresia. For good results, careful suctioning is performed to clear excess mucus, and a topical decongestant is applied. The purpose of CT scanning is outlined as follows:

  • Confirm the diagnosis of choanal atresia (unilateral or bilateral).
  • Evaluate choanal atresia (vomer bone width and choanal airspace distance).
  • Exclude other possible nasal sites of obstruction.
  • Determine the degree of bony, membranous, or mixed atresia.
  • Delineate abnormalities in the nasal cavity and nasopharynx.

CT scan image of choanal atresia is seen below.

Choanal atresia. CT scan showing membranous and boChoanal atresia. CT scan showing membranous and bony choanal atresia. From T.L. Tewfik and V.M. Der Kaloustian, with permission.
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Diagnostic Procedures

  • Failure to pass an 8F catheter through the nasal cavity more than 5.5 cm from the alar rim
  • The lack of movement of a thin wisp of cotton under the nostrils while the mouth is closed
  • The absence of fog on a mirror when it is placed under the nostrils
  • Acoustic rhinometry
  • Listening for breath sounds with either a stethoscope or a Toynbee auscultation tube
  • Gently blowing air into each nasal cavity with a Politzer bag
  • Administering into the nose a colored solution that is visible in the pharynx
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Contributor Information and Disclosures
Author

Ted L Tewfik, MD, FRCSC  Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Continuing Medical Education of Otolaryngology, McGill University Medical School; Director of Professional Affairs of Otolaryngology, Division of Otolaryngology, Montreal Children's Hospital; Senior Staff, Montreal General Hospital and Royal Victoria Hospital

Ted L Tewfik, MD, FRCSC, is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society of Pediatric Otolaryngology, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Yaser ALI Alrajhi, MD, FRCSC  Fellow, Department of Otolaryngology, Division of Pediatric Otolaryngology, McGill University Faculty of Medicine

Disclosure: Nothing to disclose.

Abdulrahman A Hagr, MBBS  Otolaryngology Consultant, King Abdulaziz University Hospital; Associate Professor, King Saud University

Abdulrahman A Hagr, MBBS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell A Faust, MD, PhD  Consulting Staff, Department of Otolaryngology, Columbus Children's Hospital

Russell A Faust, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Legal Medicine, American Laryngological Rhinological and Otological Society, American Rhinologic Society, American Society for Head and Neck Surgery, and American Society of Law, Medicine & Ethics

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gregory C Allen, MD  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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Choanal atresia. Rhinogram demonstrating blockage of radiopaque dye at the posterior choanae. From T.L. Tewfik and V.M. Der Kaloustian, with permission.
Choanal atresia. CT scan showing membranous and bony choanal atresia. From T.L. Tewfik and V.M. Der Kaloustian, with permission.
Choanal atresia. Diagram illustrating the transpalatal correction of choanal atresia.
 
 
 
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