Choanal Atresia Repair Using Mucoperiosteal Flaps Without Stenting: 10-Year Experience.

Abstract

Congenital choanal atresia (CCA) is a rare craniofacial anomaly that may present as a neonatal emergency or with delayed symptoms in childhood. Although endoscopic endonasal repair is the current standard of care, data on long-term functional outcomes and factors associated with revision surgery remain limited. This study evaluates clinical characteristics, surgical outcomes, and predictors of relook surgery following endoscopic endonasal CCA repair using mucosal flaps without stenting. A retrospective single-center study was conducted including children (≤ 18 years) who underwent unilateral or bilateral CCA repair at a tertiary referral pediatric hospital, between 2015 and 2025. Data on surgical technique, perioperative complications, and long-term functional outcomes were analyzed. Thirty-six patients underwent endoscopic endonasal CCA repair (23 unilateral CCA, 13 bilateral CCA). Postoperatively, granulation tissue, synechiae, and restenosis occurred in 22%, 33%, and 39% of cases, respectively, resulting in a relook surgery rate of 47%, most commonly within the first postoperative month. Long-term neochoanal patency was achieved in 97% of patients. Endoscopic endonasal CCA repair yields excellent long-term patency with low morbidity. However, restenosis and relook surgery remain common, underscoring the need for vigilant postoperative follow-up and optimized management strategies.