Department of Otorhinolaryngology, Head and Neck Surgery, Tübingen University Hospital, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, Tübingen University Hospital, Germany.
Int J Pediatr Otorhinolaryngol. 2022 Sep;160:111240. doi: 10.1016/j.ijporl.2022.111240. Epub 2022 Jul 14.
Choanal Atresia is a congenital condition that presents as a blockage from the nasal cavity to the nasopharynx. According to the German statistical Institute (Statistisches Bundesamt), the incidence in Germany in 2018 reached 2.74 in 10,000 live births. It can present unilaterally or bilaterally. As newborns are obligate nasal breathers, management of bilateral atresia has to be performed early after birth. As for unilateral atresia, the optimal age for treatment was determined to be between 6 and 12 months in a recently published consensus.
The main purpose of this study is to characterize the patients treated for choanal atresia in the Department of Otorhinolaryngology and Head and Neck Surgery at a tertiary hospital in the south of Germany and, based in the demographic characteristics as well as intra- and post-operative treatment, to identify factors for success or failure of the surgery. A secondary goal was to describe the complications in the use of stents and analyse its influence in the results.
The cohort-based observational study included 29 patients, with a minimum follow up of one year, who underwent surgical endoscopic correction of both unilateral and bilateral choanal atresia from 2003 to 2020. Analysis of the demographics, intraoperative, and postoperative treatment, and their results, was performed. Multinomial logistic regression was applied for categorical values. Comparisons were performed using Fischer/chi-square test where applicable. A significance level of 0.05 was reached.
The population was comprised of 34.5% male and 65.5% female patients. The age varied from 2 days to 20 years old, with a mean of 4.98 years and Standard Deviation (SD) 6.88. The weight of the patients varied between 1.4 kg and 85.0 kg, with a mean of 19.36 and SD 22.58. Unilateral choanal atresia was present in 58.6%, and bilateral in 41.4%. Out of this population, 48.3% presented with associated malformations. The number of procedures per patient performed in general anesthesia varied from 1 to 9, with a mean of 2.52 and SD of 2.23: statistically higher for patients presenting with bilateral atresia with a p value of 0.001*. 20 patients had a tube (Vygon, France) placed at first surgery. In 5 patients, a drug-eluting stent (Propel mini ; Intersect ENT, USA) was applied intraoperatively, without complications. In unilateral choanal atresia, surgical and functional success was attained in 88.2% of the cases. In bilateral cases, it reached 75%. We observed a strong linear relationship between the weight of the patient and the size of the choana perioperatively: R quadrat 0.596, which may be a determinant factor in the wound healing. Weight, age, and concomitant pathology achieved statistical significance in the logistic regression model (p respectively 0.001*, 0.001* and 0.010*), which shows its influence in the result of the surgery. In particular, weight inferior to 3 kg (p 0.001*, chi-square test) at the time of the first surgery is a determinant demographic factor for need of revision in order to achieve patency. There were no major complications associated with the use of a stent, besides its dislodgement. We could not infer an implication of its use on the success of the surgery in the present cohort.
for this study were the small size of the cohort and non-standardized records for some variables.
Younger patients presenting with low weight and concomitant pathology have worse results after surgical endoscopic treatment of choanal atresia, revealing these characteristics to be determinant for success. The size of the neochoana is related to the weight of the patient, which is a limiting factor. In particular, patients under 3 kg had to undergo more procedures in order to achieve patency. The implication of the use of locally applied medication needs to be further studied.
后鼻孔闭锁是一种先天性疾病，表现为鼻腔至鼻咽部的阻塞。根据德国统计研究所（Statistisches Bundesamt）的数据，2018 年德国的发病率达到每 10000 例活产中有 2.74 例。它可以单侧或双侧出现。由于新生儿是强制性的鼻呼吸者，因此必须在出生后早期对双侧闭锁进行处理。对于单侧闭锁，最近发表的一项共识确定了治疗的最佳年龄在 6 至 12 个月之间。
本研究的主要目的是描述在德国南部一家三级医院耳鼻喉科和头颈部外科接受治疗的后鼻孔闭锁患者的特征，并根据人口统计学特征以及术中术后治疗，确定手术成功或失败的因素。次要目标是描述支架使用中的并发症，并分析其对结果的影响。
本队列观察性研究包括 29 名患者，他们至少随访了一年，这些患者在 2003 年至 2020 年间接受了单侧和双侧后鼻孔闭锁的手术内镜矫正。对人口统计学、术中、术后治疗及其结果进行了分析。应用多变量逻辑回归对分类值进行分析。在适用的情况下，使用 Fischer/chi-square 检验进行比较。达到了 0.05 的显著性水平。
该人群包括 34.5%的男性和 65.5%的女性患者。年龄从 2 天到 20 岁不等，平均年龄为 4.98 岁，标准差（SD）为 6.88。患者体重从 1.4 公斤到 85.0 公斤不等，平均体重为 19.36 公斤，标准差为 22.58 公斤。单侧后鼻孔闭锁占 58.6%，双侧占 41.4%。在这一人群中，48.3%的患者伴有相关畸形。一般麻醉下每位患者进行的手术次数从 1 次到 9 次不等，平均为 2.52 次，标准差为 2.23 次：对于双侧闭锁的患者，手术次数更高，p 值为 0.001*。20 名患者在第一次手术时放置了管子（Vygon，法国）。在 5 名患者中，术中应用了药物洗脱支架（Propel mini；Intersect ENT，美国），没有并发症。在单侧后鼻孔闭锁中，88.2%的病例手术和功能成功，双侧病例为 75%。我们观察到患者体重和围手术期后鼻孔大小之间存在很强的线性关系：R 平方为 0.596，这可能是伤口愈合的决定因素。体重、年龄和伴发疾病在逻辑回归模型中具有统计学意义（p 分别为 0.001*、0.001和 0.010），表明它们对手术结果有影响。特别是，在第一次手术时体重低于 3 公斤的患者（p 0.001*，卡方检验）需要进行修正以实现通畅，这是决定需要再次手术的一个决定因素。支架使用没有出现与主要并发症相关的问题，除了支架移位。我们不能推断在本队列中支架的使用对手术的成功有影响。
本研究的局限性在于队列规模较小，以及一些变量的记录不标准化。
接受手术内镜治疗后鼻孔闭锁的年轻患者、体重较轻和伴有其他疾病的患者的结果较差，这表明这些特征是成功的决定因素。新后鼻孔的大小与患者的体重有关，这是一个限制因素。特别是，体重低于 3 公斤的患者需要更多的手术才能实现通畅。局部应用药物的影响需要进一步研究。
