Navigation-assisted endoscopic U-flap technique and steroid-eluting stent for choanal atresia repair

Objectives: Surgery is the only treatment for congenital choanal atresia (CCA). It is crucial to avoid postoperative restenosis or re-occlusion of the neo-choana. This study investigated the efficacy of a navigation-assisted endoscopic endonasal U-flap technique and a bioabsorbable steroid-eluting stent for CCA repair.

Methods: A retrospective analysis was performed on 26 patients with CCA, divided into two groups (Group A and Group B). All the patients underwent navigation-assisted endoscopic endonasal resection of the atretic plate. In Group A, a silicone tube was placed to support the neo-choana and retained for 3 weeks, while in Group B, double U-flaps combined with a bioabsorbable steroid-eluting stent were used to support the flaps and the neo-choana. From the 4th week after surgery, the patients were given a budesonide inhalation suspension via transnasal nebulization for 4 weeks. Fiberoptic nasopharyngoscopy was performed at the 4th week, the 6th week, 2 months, 3 months and 6 months after surgery to observe surgical complications and neo-choana patency. The number of cases of restenosis and the number of complications occurring post-operatively were recorded for both groups.

Results: The operation success rate in Group A was 63.6 % (7/11), while the operation success rate in Group B was 100 % (15/15). There was a significant difference in the success rate between the two groups (P < 0.05). Patients in Group B exhibited a higher operation success rate, a more comfortable postoperative experience and an absence of complications.

Conclusion: Navigation-assisted endoscopic endonasal resection of the atretic plate with two U-shaped mucoperiosteal flaps, a steroid-eluting stent, and post-operative transnasal glucocorticoid nebulization is a minimally invasive, precise and safe technique that is more effective in maintaining the patency of the neo-choana and is less recurrent in patients with CCA.