Hoans are internal funnel-shaped nasal openings. They are the transition of the nasal cavity to the nasopharynx. Atresia of the choan is an abnormal condition characterized by full or partial filling of the nasal openings with immature mesenchymal tissue. The pathology is severe and dangerous, because the natural respiratory process is disrupted.
general information
By anatomy, the nasal cavity through the choana communicates with the pharynx. It is through the internal nostrils that the inhaled air passes into the upper respiratory tract. Their main function is to disinfect the air entering the lungs, moisturize and warm it. This site is also responsible for olfactory function. This is due to the presence of olfactory epithelium.
The closure of the internal nostrils is difficult to tolerate by infants, since nasal breathing is predominant in them. Atresia of choan in newborns is a malformation. Congenital malformation of the nasal openings is not uncommon. Most often associated with bone tissue overgrowth. The thickness of the atresia varies from 1 to 1.5 millimeters. Congenital overgrowth can be combined with other abnormalities of intrauterine development:
- Gothic palate is a pathology of the development of the jaw and nasopharynx.
- Cleft lip.
- Combined splitting of the iris.
- Cleft palate.
- Extra ear tragus.
Acquired choanal overgrowth can form at any age as a result of trauma or inflammation.
Pathology classification
Systematize diseases in order to accurately diagnose and prescribe adequate treatment.
Classification of hoan overgrowth due to development:
- Congenital It develops due to a violation of the process of separation of the nasal cavity from the pharynx during embryonic development.
- Acquired. It arises as a result of severe inflammatory, infectious diseases of the nose, impaired olfactory organ integrity.
By prevalence of infection:
- Unilateral - patency of one half of the nose is impaired. More often diagnosed at an older age.
- Bilateral - both halves of the organ of smell are infected. Incorrect formation of the facial skeleton is observed.
- Complete. In newborns with an untimely diagnosis, it can cause death asphyxiation.
- Partial With a significant, but not complete narrowing, they talk about stenosis.
Given the nature of the tissue that has grown, the following are distinguished in choanas:
- Bone. In 50% of cases combined with craniofacial abnormalities.
- Webbed.
- Bone-webbed. It looks like a ring with an inner membrane.
According to ICD-10, atresia of the choan has the code Q30. Refers to congenital abnormalities of the respiratory system.
The causes of atresia of the choan
The etiology and pathogenesis of a congenital disease is still not fully understood. There is a wide variety of factors that lead to the formation of anomalies. The internal causes of atresia of the choanas include changes in the egg and sperm, and the external ones are the effects of biological, chemical and other processes.
Otolaryngologists refer the following to the main factors that can cause an anomaly of choanas:
- Chronic pathologies of the mother (bronchitis, tonsillitis, diabetes mellitus).
- Infectious diseases that a woman has had during pregnancy (measles, flu, toxoplasmosis, rubella, chlamydia).
- Taking drugs with a negative effect on the zygote and blastocyst (antibiotics, barbiturates).
- Exposure to unfavorable radiation background.
- The presence of bad habits (alcoholism, smoking).
The hereditary nature of the formation of atresia of the internal nasal openings remains a controversial issue.
Acquired atresia often occurs due to serious injuries, but there are other factors:
- Nose burns.
- Connective tissue scarring after purulent-inflammatory processes in the nose (purulent rhinitis, ozena, sphenoiditis).
- Diseases of the upper respiratory tract of bacterial genesis.
- Systemic lupus erythematosus.
- Syphilis in advanced forms.
How is the disease manifested?
Congenital complete atresia of the choan is considered the most dangerous. In newborns, nasal breathing is predominant, and its complete shutdown can become life-threatening for the child. During feeding, the inability to breathe through the mouth leads to the development of hypoxia, impaired gas exchange in the lungs, asphyxiation may occur.
The clinical manifestations of partial congenital obstruction of the choan depend on the degree of their overgrowth, the morphological structure of the tissue, the age of the child, and timely diagnosis. Bilateral atresia can cause the development of certain pathologies:
- Violation of the formation of the facial skeleton.
- Improper tooth growth.
- Lag in development, especially in the mental.
- Protein-energy deficiency.
In older children, fusion of the holes appears in the form of the following symptoms:
- The nasal tone of voice.
- Change in taste and smell. This helps to reduce the child's appetite.
- The child complains of frequent headaches.
- Purulent discharge from the nose. This leads to the formation of pathologies of the ENT organs and bronchopulmonary system.
Diagnostic Methods
Modern examination methods make it possible to easily recognize congenital malformations of the nose. The diagnosis is made on the basis of an examination of ENT organs, the results of various studies and, of course, an assessment of the general condition of the child. Most diagnostic methods are available in outpatient settings.
- Endoscopic examination is carried out using rigid or fiber-optic technology. The method allows you to assess the condition of the mucosa in the area of the choan, to identify the presence of adenoid vegetation, polyps, tumors, synechia.
- CT of the skull is necessary for the diagnosis of congenital malformations of the nasal cavity and nasopharynx. Using this method, it is possible to differentiate bone and membrane forms of hole fusion. Computed tomography makes it possible to assess the pathological anatomy of the nasal cavity during pathology, the size of the open hole, the width of the opener.
- Using anterior rhinoscopy, color, moisture of the mucous membrane, size of the nasal concha are assessed, and how the nasal septum is located.
- Rear rhinoscopy allows you to assess the position of the opener, the presence of hypertrophy, polyps.
- Probing of the nasal cavity allows you to assess the density of the tissue that covers the lumen.
- Olfactometry - a method for determining the speed of smell in children is rarely used, because the range of familiar smells is small compared to adults.
How is pathology treated?
The only method of treatment for choanal atresia is surgery. The purpose of the surgery is to restore the lumen for the natural passage of air. There are 4 types of correction of overgrowth, they differ in approach to the site of atresia:
- Endonasal. The method is considered the simplest with little blood loss. But after its application, a repeated narrowing is often observed.
- Transpalatin. The operation is traumatic for children, accompanied by large blood loss. After such an intervention, children are observed for a long time at a craniofacial surgeon and dentist.
- Transeptal. It has no contraindications for use in childhood, the likelihood of restinosis is minimal.
- Transmaxillary. The method in childhood is not used due to the risk of damage to the tooth buds.
The choice of methods depends on the type of atresia, age and condition of the patient.
Correction Technique
The operation is performed under endotracheal anesthesia. After hydroseparation of a volume defect (mucoperioste) of the nasal septum, a Z-shaped incision is made. Separate so as to open access to the bone obliteration of the choana. After cartilage is cut vertically down. Through access, the bone section of the nasal septum is isolated, after detailed visualization and evaluation of the vomer.
Thick atresia is first drilled, and then the hole is expanded with a flat chisel, saw or bone forceps.
The operation is completed by the introduction of a protector-dilator into the lumen, it is adjusted in length and width. An elastic swab is introduced into the opposite half of the nose for two days. Protectors change every 7 days.
How much does nose surgery
The price consists of several factors. For convenience, we can take as an example the prices for procedures and operations in Moscow. Based on the fact that the megalopolis has the most expensive medical services, you can find out how much the treatment of choan patency impairment will cost.
- Consultation of an ENT doctor - about 2,000 rubles.
- X-ray of the skull - 1 700 rubles.
- Rhinoscopy - 1 200 r.
- CT of the skull - 4,000 p.
- Radiation diagnosis of the skull - 4 400 p.
- Correction of atresia of the choan - 29 500 rubles.
Postoperative therapy
To reduce the likelihood of negative consequences and relapses and for quick healing, intranasal therapy is prescribed in the postoperative period:
- Toilet nasal using seawater solutions or 0.9% sodium chloride aqueous solution. The task of irrigation and elimination procedures is the removal of nasal discharge.
- Vasoconstrictor drugs - decoders ("Nazivin", "Naphthyzin", "Otrivin").
- Anti-inflammatory therapy. Drugs help reduce pain.
- Mucolytic therapy provides drainage function of the lungs. Mucolytic drugs are prescribed to children without fail.
- Topical antibiotic therapy is the main preventive method of complications.
Complications
The use of the surgical method is a violation of the integrity of the tissues of the organ. The likelihood of complications after correction of atresia is low, but the following manifestations can sometimes be observed:
- Bloody discharge from the nose.
- Infectious and inflammatory processes.
- Pain
- Temperature rise.
- Re-healing due to scarring of the tissue.
At the first symptoms, you should consult an otolaryngologist. To reduce the likelihood of complications, all instructions and recommendations must be strictly observed. If it is impossible to independently carry out any procedures, this should be reported to the doctor.
Rehabilitation
The first 3-4 days, the patient is observed in a hospital. After discharge, he continues to independently carry out all the prescribed procedures. On average, the patient is almost completely restored after treatment for choanal atresia after 2 months.
After surgery, close attention should be paid to hygiene of the nasal cavity. It is imperative to carry out the morning and evening nose toilet using saline or sea water solutions.
For a while, you should refuse to visit the baths, sports. In cool times, shorten walks with the child, but do not rule out.
How to prevent pathology
In order to prevent the development of atresia, and so that the question does not arise, how much surgery on the nose costs, it is necessary to carry out preventive measures.
- To refuse from bad habits.
- Avoid nasal damage.
- Prevent the transition of various diseases into chronic forms. In time, consult a doctor and perform all therapeutic measures.
- During pregnancy, carefully monitor your health. Any drugs should be taken only after consulting a gynecologist.
These simple actions will avoid atresia of the choan.