First of all, it is worth paying attention to the meaning of the terms “atresia” and “choana”.
Atresia is a pathological condition in which natural openings and passages in the human body are absent for various reasons.
Choanas are funnel—shaped internal nasal openings of a person, which normally separate the nasal cavity and nasopharynx.
The content of the article:
Classification of hoan atresia
Clinical manifestations of hoan atresia
Methods of diagnosis of hoan atresia
Treatment of hoan atresia
Atresia hoan
Thus, hoan atresia is a developmental anomaly characterized by a complete or partial absence of physiological openings between the nose and nasopharynx (hoan). In this case, the lumen of the hoan is completely or partially filled with connective, bone or cartilage tissue.
Such pathology can be congenital and acquired. It is worth noting that congenital hoan atresia is much more common than the acquired form of this disease.
The acquired form of hoan atresia may occur after any radical surgical intervention in the nasal lumen area. Such complications are quite rare and are the result of the patient’s predisposition to the rapid formation of scar tissue. Also, acquired hoan atresia may be the result of various injuries to this area or various infectious diseases.
The pathogenesis of congenital hoan atresia is the subject of scientific debate. Some scientists tend to believe that congenital hoan atresia is the result of intrauterine development delay, others point to a genetic predisposition to such pathology, others consider hoan atresia to be a consequence of various infectious diseases suffered by the mother during pregnancy and the use of various drugs that are recognized as toxic to the embryo.
Classification of hoan atresia
There are several different forms of this disease and a certain classification that allows you to determine the nature of the pathology. According to the localization of the pathological process, it is customary to distinguish one- and two-sided atresia. Unilateral atresia of the choanal region has a lighter course, while the bilateral form of this pathology makes nasal breathing impossible and often leads to hypoxia of newborns.
It is also customary to distinguish complete and partial hoan atresia. Under complete atresia, it is customary to understand the absence of holes in the partition covering the lumen of the choan. With a partial form of this pathology, there are holes in this septum.
According to the nature of the tissues that formed the septum in the lumen of the hoan, it is customary to distinguish cartilaginous, bony and membranous forms of hoan atresia. However, there are cases of a mixed form of this pathology. The most common among the mixed forms is the bone-webbed atresia hoan, which is a bony ring with a membrane inside.
Clinical manifestations of hoan atresia
First of all, it is worth dwelling on congenital hoan atresia, since it occurs in medical practice more often than acquired. The symptoms of the disease directly depend on the form of the pathological process. So unilateral hoan atresia often proceeds asymptomatically or the symptoms are not clearly expressed. Such pathology can not be detected immediately. On the contrary, bilateral or complete hoan atresia has a number of very characteristic symptoms. Among them:
with complete atresia, a newborn child has a lack of nasal breathing, and the child can breathe only through the mouth;
with a unilateral process, nasal breathing is difficult;
the baby’s breathing is noisy;
complete or partial inability to feed;
a child can breathe normally only when he is awake and crying due to an unformed reflex of oral breathing;
characteristic discharge from the nose.
If nasal breathing is not possible, then the baby is shown intubation immediately after delivery and immediate surgery. Otherwise, the baby quickly develops hypoxia (insufficient oxygen both in the body as a whole and in individual organs and tissues), and in some particularly severe cases — asphyxia (suffocation). This condition can cause the death of a newborn.
With unilateral atresia, symptoms may not be detected in a child immediately, but even in infancy, the baby has the phenomena of obstructed nasal breathing, purulent or mucous discharge from one half of the nasal cavity. If there are suspicions, the baby’s parents need to urgently contact an otolaryngologist or a general practitioner.
Bilateral partial atresia can cause chronic hypoxia. Due to the constant violation of oxygen saturation of organs and tissues, a child may have a number of disorders of physical and mental development (atypical formation of the facial skeleton, incorrect teething, lag in the mental development of the child, etc.).
In adult patients, symptoms of partial atresia are difficulty in nasal breathing, impaired sense of smell and purulent-mucous discharge from the affected nasal opening. The patient forms a kind of plug of mucus, which involuntarily pours out when the head is tilted down.
Methods of diagnosis of hoan atresia
In newborns, the diagnosis of complete hoan atresia does not cause difficulties. Moreover, every second child born with a similar pathology has several other malformations, including craniofacial anomalies (cleft lip, cleft palate and others). Also, hoan atresia is often part of a CHARGE-association, that is, a certain symptom complex characteristic of children with a lag in physical development.
The following methods are used for diagnosis:
anamnesis analysis;
examination of the nasal cavity, which is carried out in order to establish a differential diagnosis with a violation of the patency of the nose due to the ingress of foreign bodies into the holes of the hoan and examination of the mucous membrane of the nasal cavity;
probing of the nose in order to determine the localization of atresia and its nature;
nasal cavity endoscopy is used as a defining visualizing instrumental method for diagnosing hoan atresia;
computed tomography with layered images to determine the nature of pathological changes in the nasal cavity;
additional consultation with a general practitioner.
Treatment of hoan atresia
The only effective method of treating hoan atresia is surgical intervention. For babies with congenital pathology, the operation is performed on the first day after delivery. This is very important, since the child can only breathe through the nose, and untimely correction of pathology can lead to negative consequences, up to a fatal outcome.
There are two methods of conducting surgical surgery to restore hoan atresia. The choice of method depends on the nature of the tissues involved in the fusion of the respiratory passages. If the tissue is bone, then the patient is shown an operation that is performed using a cut of the palate (transpalatilnoe intervention), in other cases, it is possible to conduct the operation by inserting instruments through the patient’s nostrils. Transpalatin access during surgery to restore hoan atresia is preferable, since it provides the surgeon with optimal visual control of the operated area. This operation is the safest and provides good long-term results.
The operation is performed in a hospital under general anesthesia. During the operation, the doctor installs special nasal stents that form the xoan lumen. After some time, these stents are removed in a hospital setting.
After the operation, the child can breathe freely and eat normally. In most cases, the operation is successful, without any complications. For several days after the operation, the child remains in the hospital under the supervision of medical personnel. After that, the baby can be discharged home (older children are discharged earlier, after 2-3 days).The complete restoration of the hoan lumen after surgery is a rather long process (1-2 months). During this period, the child needs constant monitoring of the dynamics of postoperative recovery and regular consultations with an otolaryngologist. When the hoan is re-grown, another surgical operation is performed. It should be borne in mind that each subsequent intervention only aggravates the process. Exact compliance with all the recommendations of specialists will help to avoid such a situation.
Among the most common complications are repeated overgrowth of hoan, nosebleeds and the occurrence of an inflammatory process. The child needs careful care, constant toilet of the nose and constant lubrication of its cavity with a solution of adrenaline. Specialists of medical institutions will consult you in more detail about the toilet of the nasal cavity in the postoperative period. If the baby has started bleeding from the nose or throat, the temperature has increased or other changes in the somatic state are observed, you should immediately seek medical help. Otherwise, the prognosis of treatment is favorable with timely surgery.
Preventive measures to prevent congenital pathologies are of great importance. First of all, the registration of the expectant mother with a gynecologist. Carrying out various diagnostic measures (ultrasound, genetic screening, etc.), allows you to identify disorders in the development of the fetus at the earliest stages of pregnancy. In some cases, timely medical intervention can prevent the development of severe congenital pathologies. Rational nutrition, a healthy lifestyle and constant consultations of specialists will help to avoid many health problems of your baby in the future.
