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Advancements in Choanal Atresia Repair at Rady Children’s

A Comprehensive Approach with Bioabsorbable Steroid-Eluting Stents


Choanal atresia, characterized by the failure of one or both posterior nasal apertures to canalize, has presented clinicians with unique diagnostic and therapeutic challenges. A recent case, led by Dr. Vijay Patel, a pediatric otolaryngologist and rhinologist at Rady Children’s Hospital-San Diego, sheds light on the recent advancements in its surgical management, particularly through the utilization of bioabsorbable, steroid-eluting stents.

With an incidence ranging from 1 in 5,000 to 8,000 live births, unilateral choanal atresia typically manifests as persistent nasal obstruction and rhinorrhea, often eluding definitive diagnosis for years. Over the last 165 years, a variety of surgical techniques have been employed for choanal atresia repair, with variable success rates.

In recent years, the endoscopic endonasal approach has emerged as the gold standard, offering a balance between high efficacy and minimal morbidity. Despite the strides made in minimally invasive techniques, the reported rate of restenosis and reoperation, particularly for bilateral cases, remains high, reaching upwards of 90%.

Breakthrough Techniques at Rady Children’s

Recent work led by Dr. Patel at Rady Children’s demonstrates a reproducible technique for managing bilateral choanal atresia in neonates. This involves a single-stage endoscopic endonasal approach coupled with the deployment of a bioabsorbable, steroid-eluting stent. In this patient case, Dr. Patel performed an endoscopic elevation of mucosal septal flaps and maximal opening of bilateral choanal atresia with subsequent nasal reconstruction. Deployment of the bioabsorbable stent ensured neochoanal patency and minimized long-term restenosis. The patient was immediately extubated following the procedure, and postoperative care involved regular nasal saline administration and in-office nasal debridement. Follow-up includes routine serial in-office nasal endoscopy to ensure nasal patency and monitoring for any signs of obstruction or restenosis.

“The utility of bioabsorbable, steroid-eluting stents is groundbreaking for children with congenital nasal stenoses. Following single-stage endoscopic repair, this dissolvable implant allows for localized, controlled release of corticosteroids, which minimizes excess scarring and restenosis with essentially normal nasal breathing following surgery,” said Dr. Patel.

The use of bioabsorbable, steroid-eluting stents in choanal atresia repair has shown promising results, with studies reporting a significant reduction in restenosis and reoperation rates. This approach not only provides physical support for flap coaptation but also mitigates excess inflammation and edema. It also addresses unique perioperative challenges such as the need for reoperation, as well as positive implications for patient outcomes and health care providers.

About Dr. Vijay Patel

As part of the Division of Otolaryngology of Rady Children’s Specialists of San Diego, Dr. Patel specializes in caring for newborns, children, and adolescents with ear, nose, throat, neck, and airway problems. Dr. Patel is the only dual fellowship-trained rhinologist and pediatric otolaryngologist on the West Coast. In addition to caring for all children with pediatric ear, nose, and throat disorders and conditions, Dr. Patel’s specific clinical and research interests include skull base surgery, cystic fibrosis, primary ciliary dyskinesia, congenital nasal anomalies, rhinosinusitis, sinonasal disorders, nasal airway obstruction, lymphovascular anomalies, and surgical outcomes, cost analysis, and quality improvement metrics in surgery. He has more than 70 peer-reviewed publications and 50 regional/national presentations in otolaryngology and is active across several professional expert networks worldwide.

To learn more, visit the Division of Otolaryngology at Rady Children’s.