Review Article
International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Diagnosis, pre-operative, operative and post-operative pediatric choanal atresia care

https://doi.org/10.1016/j.ijporl.2019.05.010Get rights and content

Abstract

Objective

To provide recommendations to otolaryngologists and allied physicians for the comprehensive management of young infants who present with signs or symptoms of choanal atresia.

Methods

A two-iterative delphi method questionnaire was used to establish expert recommendations by the members of the International Otolaryngology Group (IPOG), on the diagnostic, intra-operative, post-operative and revision surgery considerations.

Results

Twenty-eight members completed the survey, in 22 tertiary-care center departments representing 8 countries. The main consensual recommendations were: nasal endoscopy or fiberscopy and CT imaging are recommended for diagnosis; unilateral choanal atresia repair should be delayed after at least age 6 months whenever possible; transnasal endoscopic repair is the preferred technique; long term follow-up is recommended (minimum one year) using nasal nasofiberscopy or rigid endoscopy, without systematic imaging.

Conclusion

Choanal atresia care consensus recommendations are aimed at improving patient-centered care in neonates, infants and children with choanal atresia.

Section snippets

Consensus objectives

To provide recommendations for the comprehensive management of young infants who present with signs or symptoms of choanal atresia.

Choanal atresia is characterized by blockage of the posterior part of the nose, usually by abnormal bony or soft tissue due to failed recanalization of the nasal fossae during fetal development [1]. According to the literature, bilateral choanal atresia accounts for 30% of patients, while unilateral choanal atresia accounts for about 70% of cases [2]. Bilateral

Target population

All pediatric patients with signs concerning for choanal atresia, with special focus on the first two years of life.

Intended users

These consensus recommendations are intended to inform:

  • 1.

    Otolaryngologists who perform choanal atresia surgery

  • 2.

    Allied physicians, including intensive care unit specialists and pediatricians, who collaborate in the care of these patients.

Methods

Consensus guidelines based on the review of the literature and expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative delphi method questionnaire was used to establish expert recommendations on the diagnostic considerations, intra-operative considerations, post-operative considerations and revision surgery. An online survey was designed by two authors of the group (EM and RN). The survey was distributed to all members of the IPOG, and responses

Disclaimer

Members of the International Pediatric ORL Group (IPOG) prepared this report. Consensus recommendations are based on the collective opinion of the members of this group. Any person seeking to consult this report or apply its conclusions to patient care is expected to use independent medical judgment in the context of individual patient and institutional circumstances.

Recommendations and justification

Twenty-eight members completed the survey, in 22 tertiary-care center departments representing 8 countries including Australia, Canada, France, Ireland, Italy, Portugal, the United Kingdom, and the United States of America. The results of the survey are summarized in Table 1 and outlined in the following subheadings:

  • 6.1

    Pre-operative considerations

  • 6.2

    Intra-operative considerations

  • 6.3

    Post-operative considerations

  • 6.4

    Revision Surgery

Conclusion

Choanal atresia care consensus recommendations are aimed at improving patient-centered care in neonates, infants and children with choanal atresia. Diagnosis is made by the combination of nasofiberscopy or nasal rigid endoscopy and CT imaging. Unilateral choanal atresia repair should be delayed after at least age 6 months whenever possible. Transnasal endoscopic repair is the preferred technique for bilateral and unilateral choanal atresia whenever possible. Long-term follow-up is recommended

Conflicts of interest

None.

Acknowledgments

Drs Richard Nicollas (senior author) and Eric Moreddu (first author) were the lead authors and Dr Mark Rizzi provided primary consulting and guidance regarding the design and the wording of the consensus recommendations. All remaining authors are listed in alphabetical order. The authorship list follows the agreement of the members of the IPOG. All authors have contributed to the conception and the design of the work, drafting and revising the consensus recommendations for important

References (8)

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