Septonasal Bidirectional Mucoperiosteal Flap Applying In Treatment Of Refractory Choanal Atresia In Adults

[Abstract] Objective To discuss the effects of septonasal bidirectional mucoperiosteal flap in the treatment of refractory choanal atresia in adults. Method Analysis of 9 cases for choanal atresia (males 4 and females 5, unilateral 2 and bilateral 7, congenital 2 and acquired 7) from July 2006 to June 2009. Radiotherapy for nasopharyngeal carcinoma was the reason for all the 7 acquired choanal atresia. Within the 9 patients,2 cases of each type were the second time surgery. All the patients received the transnasal endoscopic surgical technique, using the septonasal bidirectional mucoperiosteal flap. The patients were not placed the expansion tube postoperatively. After the operation, the changes of symptoms were observed and the recurrent rate of restenosis or atresia was investigated in follow-up time. Results The symptoms of nasal obstruction and mouth breathing improved significantly in the 9 patients. At an average follow-up time of 19.3 months, the nasal endoscopic examination showed the new forming posterior nare and nasopharynx were unobstructed. The mucoperiosteal flap had no shift and necrosis, and there were no restenosis or atresia happened. Two patients occurred the nasal adhesion and 1 occurred the granulation tissue hyperplasia at the edge of new forming posterior nare, of which were all the type of radiotherapy for nasopharyngeal carcinoma. All of the three patients had no recurred after the endoscopic revision. Conclusions Transnasal endoscopic surgery can be used for the acquired choanal atresia caused by radiotherapy for nasopharyngeal carcinoma, and the recurred patients also can use this method. The application of mucoperiosteal flap and recheck regularly can reduce the incidence of restenosis. Patients may not been placed the expansion tube postoperatively when the mucoperiosteal flap was used.