Die endonasale endoskopische Resektion von Choanalatresien – wie groß ist der Langzeiterfolg?

Zusammenfassung

Einleitung Die Choanalatresie gehört zur Gruppe der seltenen Fehlbildungen. Sie stellt bei beidseitigem Auftreten einen akut lebensbedrohlichen Notfall dar, da Neugeborene obligate Nasenatmer sind. Die endoskopische Resektion ist eine etablierte Therapie, die Operationstechnik ist bisher jedoch nicht standardisiert.

Methodik Die endonasal endoskopische Resektion von kongenitalen Choanalatresien bei 11 Kindern wurde retrospektiv in einem Nachbeobachtungszeitraum von 9 bis 87 Monaten analysiert. Vier Kinder wiesen eine bilaterale, sieben eine unilaterale Atresie auf. Neben der endoskopischen Resektion der Choanalatresie erfolgten die Erweiterung der Choane durch endoskopisches Abtragen des Knochens Richtung Schädelbasis und das Abtragen der hinteren Septumkante. Das intraoperative Handling, intra- und postoperative Komplikationen und die Rezidivrate im Verlauf wurden ermittelt. Eltern bzw. Patienten wurden zur subjektiven Einschätzung der Nasenatmung befragt.

Ergebnisse Intraoperative Komplikationen wurden keine beobachtet. Drei Frühgeborene wurden innerhalb der ersten Lebenswoche bei einem durchschnittlichen Geburtsgewicht von 2540 g operiert. Postoperativ kam es zweimal zu Schmierblutungen. Die langfristige Rezidivfreiheit lag bei 73 % (unilateral) bzw. 100 % (bilateral).

Schlussfolgerungen Die endonasale endoskopische Resektion von Choanalatresien mit Erweiterung der Choane Richtung Schädelbasis, Reduktion des Nasenbodens und Abtragen der hinteren Septumanteile stellt eine schonende und erfolgreiche Therapieoption dar.

Abstract

Introduction Choanal atresia is a rare abnormality. As neonates depend on transnasal respiration, bilateral choanal atresia causes an acute emergency. Transnasal endoscopic resection of congenital choanal atresia is a well-established therapy. However, the surgical technique has not yet been standardized.

Methods A retrospective chart review was performed with a follow-up examination between 9 to 87 months after surgery. 11 patients (7 with unilateral atresia, 4 with bilateral atresia) were included. The choana was opened and enlarged endoscopically by resection of the posterior septal wall and bony reduction up to skull base and nasal floor. Intraoperative handling, intra- and postoperative complications, restenosis and adequate respiratory function were assessed.

Results No intraoperative complications could be observed. Three premature babies underwent surgical intervention within their first postnatal week with an average weight of 2540 g. 2/11 patients suffered from a minor episode of epistaxis as a postoperative complication. Long-term success without restenosis was 73 % (for unilateral atresia) and 100 % for bilateral (atresia).

Conclusions Choosing an endonasal endoscopic approach to resect choanal atresia via resection of the posterior septal wall and circular bony reduction is a successful therapy with low morbidity.

Schlüsselwörter

Choanalatresie - Endoskopische Resektion - Pädiatrische HNO-Heilkunde - Operationstechnik - CHARGE-Syndrom

Key words

choanal atresia - endoscopic resection - pediatric otorhinolaryngology

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