- Original Article
- Open access
- Published:
Effect of the type of surgery, use of intraoperative topical mitomycin C or stenting on the outcome of choanal atresia repair: a systematic review and meta-analysis
The Egyptian Journal of Otolaryngology volume 32, pages 255–263 (2016)
En
Abstract
Background
Restenosis and recurrence of symptoms after posterior choanal atresia (CA) repair is a major concern for surgeons, which leads to the use of a variety of surgical approaches and adjuvant treatment modalities to avoid restenosis.
Aim
The study was designed to compare the outcome of transnasal endoscopic and transpalatal repair of CA as regards restenosis, and also to compare the effect of using topical mitomycin C (MMC) or nasal stenting with not using these modalities on the outcome of repair as regards restenosis.
Methods
A systematic search was conducted on the PubMed/MEDLINE to locate and select relevant studies without applying any limits. Studies included in meta-analysis were tested for heterogeneity of the estimates.
Results
As regards comparing the transnasal endoscopic and transpalatal approaches, eight studies, involving 410 cases, met our criteria; 197cases were repaired endoscopically with 37.5% restenosed and 188 through transpalatal approach with 28.2% restenosed. Using the estimated odds ratio, no statistically significant difference was found as regards restenosis. For the use of MMC, five articles fulfilled our criteria; they involved 155 cases; MMC was used in 70 cases where 24.2% restenosed, and was not used in 85 cases where 35.2% restenosed. By estimated odds ratio, there was no statistically significant difference between the two groups as regards restenosis. For the use of stenting, four articles fulfilled our criteria; they involved 165 cases, out of which 93 cases used nasal stent after repair of CA (21.5% restenosed), whereas in 72 cases stent was not used (18% restenosed). By estimated odds ratio there was no statistically significant difference between the two groups.
Conclusion
The available evidence suggests that there is no statistically significant difference between transnasal endoscopic and transpalatal approach in the repair of CA as regards restenosis; furthermore, there is no statistically significant difference between using intraoperative topical MMC and nasal stent and not using such modalities on the outcome of CA repair.
References
Petkovska L, Petkovska I, Ramadan S, Aslam MO. CT evaluation of congenital choanal atresia: our experience and review of the literature. Australas Radiol 2007; 51: 236–239.
Assanasen P, Metheetrairut C. Choanal atresia. J Med Assoc Thai 2009; 92: 699–706.
Al Muhaimeed H. Choanal atresia repair: 14 years’ experience. Ann Saudi Med 1999; 19:273–275.
Madry EB, Głos LZ, Chmielik M. Long-term experience in the management of choanal atresia. Borgis-New Med 2007; 4: 83–86.
Kim H, Park JH, Chung H, Han DH, Kim DY, Lee CH, Rhee CS. Clinical features and surgical outcomes of congenital choanal atresia: factors influencing success from 20-year review in an institute. Am J Otolaryngol 2012; 33: 308–312.
Gosepath J, Santamaria VE, Lippert BM, Mann WJ. Forty-one cases of congenital choanal atresia over 26 years–retrospective analysis of outcome and technique. Rhinology 2007; 45: 158–163.
Hengerer AS, Brickman TM, Jeyakumar A. Choanal atresia: embryologic analysis and evolution of treatment, a 30-year experience. Laryngoscope 2008; 118: 862–866.
Jung H. Congenital choanal atresia and surgical correction. Laryngorhinootologie 1994; 73: 586–590.
Richardson MA, Osguthorpe JD. Surgical management of choanal atresia. Laryngoscope 1988; 98: 915–918.
Wiatrak BJ. Unilateral choanal atresia: initial presentation and endoscopic repair. Int J Pediatr Otorhinolaryngol 1998; 46: 27–35.
Al-Ammar AY. Effect of use of mitomycin C on the outcome of choanal atresia repair. Saudi Med J 2007; 28: 1537–1540.
Bozkurt MK, Keles B, Azimov A, Ozturk K, Arbag H. The use of adjunctive topical mitomycin in endoscopic congenital choanal atresia repair. Int J Pediatr Otorhinolaryngol 2010; 74: 733–736.
Kubba H, Bennett A, Bailey CM. An update on choanal atresia surgery at Great Ormond Street Hospital for Children: preliminary results with mitomycin C and the KTP laser. Int J Pediatr Otorhinolaryngol 2004; 68: 939–945.
Rombaux P, de Toeuf C, Hamoir M, Eloy P, Bertrand B, Veykemans F. Transnasal repair of unilateral choanal atresia. Rhinology 2003; 41: 31–36.
Newman JR, Harmon P, Shirley WP, Hill JS, Woolley AL, Wiatrak BJ. Operative management of choanal atresia: a 15-year experience. JAMA Otolaryngol Head Neck Surg 2013; 139: 71–75.
Elsherif A, Osman Y, Abdelmoghny A, Mahrous A. Endonasal repair of choanal atresia, does stenting have a better outcome? Egypt J Ear Nose Throat and Allied Sci 2012; 13: 13–17.
Friedman NR, Mitchell RB, Bailey CM, Albert DM, Leighton SE. Management and outcome of choanal atresia correction. Int J Pediatr Otorhinolaryngol 2000; 52: 45–51.
Sadek SA. Congenital bilateral choanal atresia. Int J Pediatr Otorhinolaryngology 1998; 42: 247–256.
Pirsig W. Surgery of choanal atresia in infants and children: historical notes and updated review. Int J Pediatr Otorhinolaryngol 1986; 11: 153–170.
Shivakumar AM, Naik AS, Prashanth KB, Vishwanath B, Praveen DS. Choanal atresia: transnasal endoscopic technique. Indian J Pediatr 2003; 70: 875–876.
Panda NK, Narang A, Srinivas S. Bilateral congenital choanal atresia. Indian J Pediatr 2002; 69: 917–920.
Reddy TN, Dutt SN, Raza M. Emergency management of bilateral choanal atresia in the newborn by the endoscopic endonasal approach: a clinical record and review of literature. Int J Pediatr Otorhinolaryngol 1996; 38: 21–30.
Anderhuber W, Stammberger H. Endoscopic surgery of uni- and bilateral choanal atresia. Auris Nasus Larynx 1997; 24: 13–19.
Forer B, Landsberg R, Derowf A. Endoscopic choanal atresia repair: operative techniques. Otolaryngol Head Neck Surg 2001; 12: 224–228.
Ibrahim AA, Magdy EA, Hassab MH. Endoscopic choanoplasty without stenting for congenital choanal atresia repair. Int J Pediatr Otorhinolaryngol 2010; 74: 144–150.
Önerci TM, Yücel OT, Ögretmenoglu O. Transnasal endoscopic surgery in choanal atresia. Operat Tech Otolaryngol 2006; 17: 143–146.
Yaniv E, Hadar T, Shvero J, Stern Y, Raveh E. Endoscopic transnasal repair of choanal atresia. Int J Pediatr Otorhinolaryngol 2007; 71: 457–462.
Romeh HE, Albirmawy OA. A 13-year experience and predictors for success in transnasal endoscopic repair of congenital choanal obliteration. Int J Pediatr Otorhinolaryngol 2010; 74: 737–742.
Van Den Abbeele T, François M, Narcy P. Transnasal endoscopic treatment of choanal atresia without prolonged stenting. Arch Otolaryngol Head Neck Surg 2002; 128:936–940.
Saetti R, Santoro R, Silvestrini M, Derosas U, Barion F, Narne S. Choanal atresia: endoscopic transnasal approach. Int Congr Ser 2003; 1254: 443–445.
Schoem SR. Transnasal endoscopic repair of choanal atresia: why stent? Otolaryngol Head Neck Surg 2004; 131: 362–366.
Pasquini E, Sciarretta V, Saggese D, Cantaroni C, Macrì G, Farneti G. Endoscopic treatment of congenital choanal atresia. Int J Pediatr Otorhinolaryngol 2003; 67: 271–276.
Bergonse GF, Carneiro AF, Vassoler TMF. Choanal atresia, analysis of 16 cases-the experience of (HRACUSP) from 2000 to 2004. Braz J Otorhinolaryngol 2005; 71: 730–733.
Gujrathi CS, Daniel SJ, James AL, Forte V. Management of bilateral choanal atresia in the neonate: an institutional review. Int J Pediatr Otorhinolaryngol 2004; 68: 399–407.
Schraff SA, Vijayasekaran S, Meinzen-Derr J, Myer CM. Management of choanal atresia in CHARGE association patients: a retrospective review. Int J Pediatr Otorhinolaryngol 2006; 70: 1291–1297.
Teissier N, Kaguelidou F, Couloigner V, François M, van Den Abbeele T. Predictive factors for success after transnasal endoscopic treatment of choanalatresia. Arch Otolaryngol Head Neck Surg 2008; 134: 57–61.
Prasad M, Ward RF, April MM, Bent JP, Froehlich P. Topical mitomycin as an adjunct to choanal atresia repair. Arch Otolaryngol Head Neck Surg 2002; 128: 398–400.
Holland BW, McGuirt WFJr. Surgical management of choanal atresia: improved outcome using mitomycin. Arch Otolaryngol Head Neck Surg 2001; 127: 1375–1380.
McLeod IK, Brooks DB, Mair EA. Revision choanal atresia repair. Int J Pediatr Otorhinolaryngol 2003; 67: 517–524.
Cedin AC, Fujita R, Cruz OL. Endoscopic transeptal surgery for choanal atresia with a stentless folded-over-flap technique. Otolaryngol Head Neck Surg 2006; 135: 693–698.
Elloy MD, Cochrane LA, Albert DM. Refractory choanal atresia: what makes a child susceptible? The Great Ormond Street Hospital experience. J Otolaryngol Head Neck Surg 2008; 37: 813–820.
Durmaz A, Tosun F, Yldrm N, Sahan M, Kvrakdal C, Gerek M. Transnasal endoscopic repair of choanal atresia: results of 13 cases and meta-analysis. J Craniofac Surg 2008; 19: 1270–1274.
Uzomefuna V, Glynn F, Al-Omari B, Hone S, Russell J. Transnasal endoscopic repair of choanal atresia in a tertiary care centre: a review of outcomes. Int J Pediatr Otorhinolaryngol 2012; 76: 613–617.
Josephson GD, Vickery CL, Giles WC, Gross CW. Transnasal endoscopic repair of congenital choanal atresia: longterm results. Arch Otolaryngol Head Neck Surg 1998; 124: 537–540.
Wang QY, Wang SQ, Lin S, Chen HH, Lu YY. Transnasal endoscopic repair of acquired posterior choanal stenosis and atresia. Chin Med J (Engl) 2008; 121: 1101–1104.
Author information
Authors and Affiliations
Corresponding author
Additional information
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Rights and permissions
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.
To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
El-Begermy, M.M., Samir, M.M., Fawaz, S.A. et al. Effect of the type of surgery, use of intraoperative topical mitomycin C or stenting on the outcome of choanal atresia repair: a systematic review and meta-analysis. Egypt J Otolaryngol 32, 255–263 (2016). https://doi.org/10.4103/1012-5574.192552
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/1012-5574.192552