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Atlanto-occipital Dislocation
Joseph Junewick, MD FACR
over 8 years ago
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Right Choanal Stenosis

Case Detail

Anatomy: Neck-Face
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

Inability to pass catheter through right nares in a newborn.


Case Images


Diagnosis

Right Choanal Stenosis

Findings

CT – Axial and coronal reformatted images of the face demonstrate medial pinching of the right maxilla towards the vomer, constricting the posterior nasal cavity. Secretions are pooled in the nasal cavity. Note that the cribiform plate is cartilaginous and should not be confused with encephalocele.

Discussion

Choanal atresia/stenosis is an important cause of airway obstruction. It can be unilateral or bilateral, boney or membranous. The etiology of choanal atresia/stenosis is not known. Medial bowing and thickening of the walls of the nasal cavity (perpendicular plate of palatine bone and the pterygoid process) or enlargement of the vomer leads to stenosis wheras fusion of these element results in atresia. Occasionally, membranes contribute to the nasal airway obstruction.

The diagnosis is suggested clinically by respiratory distress relieved by establishing an oral airway and corroborated by inability to pass a nasal catheter. Bilateral disease usually presents in the neonatal period. Inability to breath through one nostril and unilateral constant stuffiness and increased nasal discharge suggests unilateral involvement. Unilateral involvement is often diagnosed later in childhood.

Choanal atresia is associated with CHARGE syndrome (coloboma, heart defect, atresia of the choanae, retarded growth, genital anomalies and ear defects), craniosynostosis, facial clefts, chromosomal defects, various syndromes (e.g., Treacher Collins, DiGeorge, Crouzon, de Lange, Antley-Bixler, fetal alcohol) and gastrointestinal anomalies (malrotation, tracheoesophageal fistula).

Reference

Slovis TL, et al. Choanal atresia: Precise CT evaluation. Radiology (1985); 155:345-348.



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