Choanal atresia
•
33 likes•9,812 views
Choanal atresia
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Choanal atresia
Similar to Choanal atresia (20)
More from Islamic university of science and technology awantipora
More from Islamic university of science and technology awantipora (20)
Recently uploaded
Recently uploaded (20)
Choanal atresia
- 1. Choanal Atresia ULFAT AMIN MSc 2nd year
- 2. INTRODUCTION • Neonatal airway obstruction leading to respiratory distress is a fairly common problem in the pediatric ICU setting. • The word “choana” comes from the Greek word meaning “funnel”. The choana is essentially the posterior nasal aperture by which air flows from the nasal cavity into the nasopharynx. The anatomic borders of the choana are as: - • Superior border: inferior surface of the sphenoid body – • Lateral border: lamina of the medial pterygoid plate (inferior projection of sphenoid bone) • - Medial border: the nasal vomer • - Inferior border: horizontal portion of the palatal bone • The following anatomic abnormalities contribute to forming the atretic choana: a narrowed nasal cavity, lateral impingement of the medial pterygoid plate, an abnormally thickened vomer, and a membrane most of mucosa and/or bone extending across the choana.
- 4. • Between 4-6 weeks of gestation, there is a formation of primitive nasal structures .At about the same time, nasal pits form and burrow into the mesenchyme to create the primitive nasal cavities. These nasal pits sit atop the frontal portion of the stomodeum (i.e primitive oral cavity), and the pits are separated from the stomodeum by the nasobuccal membrane. Once the nasobuccal membrane ruptures, the primitive nasal cavity and primitive choana are formed. The primitive choana matures and transforms into the definitive (i.e. secondary) choana
- 6. HISTORY AND EPIDEMIOLOGY • Choanal atresia was first described by a physician named Roederer in 1755. • However, the first recorded surgical repair was done in 1854 . • The condition is the most common nasal abnormality in newborn infants ,affecting about 1 in 7,000 live births. Females get this condition about twice as often as males. More than half of affected infants also have other congenital problems. • In general, unilateral choanal atresia is more common than bilateral (65-75% of patients with unilateral)
- 7. Choanal atresia • Choanal atresia is a rare condition that affects babies & is caused by a blockage of choana, which is a passage way that connects each side of nose to the throat. These passageways are essential for breathing through the nose. It is a congenital condition, meaning it is present at birth. the condition may be present as an isolated birth defect in a baby that is otherwise healthy or it could be a part of genetic disorder called charge syndrome that affect various organs.
- 8. Two types of Choanal atresia are UNILATERAL CHOANAL ATRESIA: this more common of the two & is also a less threatening, atresia effects just one side of the nasal passageways. BILATERAL CHOANAL ATRESIA: this can be a life threatening as blockage affects both passageways, causing extreme respiratory difficulty
- 9. Causes • The cause of choanal atresia is unknown. It is thought to occur when the thin tissue separating the nose and mouth area during fetal development remains after birth. Allergy and sinus disease with associated secretions and tissue swelling may contribute as well, especially in children with cystic fibrosis. In addition, nasal masses such as hemangiomas and encephalocoeles must be ruled out in any child with nasal obstruction.
- 10. Signs/Symptoms Bilateral Atresia • Presents as a newborn • Cyanosis • Increased respiratory effort • Chest retractions • Classically cyanosis/saturations improve with crying • Inability to nurse and breathe at same time. Uni lateral Atresia • Present later in life (non- emergent) • Chronic nasal discharge • Nasal obstruction • Thick nasal secretions on examination
- 11. Diagnosis • A physical exam may show an obstruction of the nose. • • Inability to pass catheter or NG tube – 6 Fr – 32 mm as proposed distance • • Absence of fogging of mirror under nose
- 12. Diagnosis Choanal Atresia Tests that may be done include: CT scan Endoscopy of the nose Sinus x-ray
- 13. CHARGE Syndrome • Coloboma ( Essentially a hole in one of the structures of the eye.) • Heart disease (TOF, PDA, DORV, VSD, ASD, Right Aortic Arch) • Atresia choanae • Retarded growth (CNS anomalies) • Genital anomalies (hypogonadism) • Ear anomalies
- 14. Treatment Resuscitate the baby if necessary. An airway may need to be placed so that the infant can breathe. In some cases, intubation or tracheostomy may be needed. Surgery to remove the obstruction cures the problem. Surgery may be delayed if the infant can tolerate mouth breathing. The surgery may be done through the nose (transnasal) or through the mouth (transpalatal). Most bilateral can be done within the first few days of life to aid in growth and development
- 15. Timing of Surgical Repair • Most bilateral can be done within the first few days of life to aid in growth and development • CHARGE syndrome may require a delay – Tracheostomy typically needed • Unilateral atresia – Before school age
- 17. • Outlook (Prognosis) • Full recovery is expected. Possible Complications Aspiration while feeding and attempting to breathe through the mouth Respiratory arrest Re narrowing of the area after surgery
- 18. NURSING MANAGEMENT Consider CA in newborn/child with symptoms of nasal obstruction There is high association of choanal atresia with other congenital defects, nurse must look for other defects also Oxygen therapy is given for respiratory distress by use of special nipple called a McGovern nipple which has a large hole in its center for air passage or a plastic oral airway piece. Input output should be maintained before and after surgery Keep the client warm. An intravenous drip is used to hydrate the patient. Monitor patients vital signs Provide oxygen in case of dyspnea and cyanosis
- 19. NURSING MANAGEMENT • All drugs to be administered keeping in mind five steps of drug administration • Suction the nasal stents so that they don’t get blocked up • Teach parents also how to suction to keep stent patent for period of three months after surgery till stent will be removed • Nurse must teach how to keep nose clean & how to give your baby nose drops • Make sure clients nasal passage is patent before starting feed.
- 20. • THANK YOU
Editor's Notes
- Choanal atresia is a congenital narrowing at the posterior choanae (the area from the nare to the nasopharynx). This is purely bony in 30% of cases and mixed bony and membranous in 70% of cases.