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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Otolaryngology

Post-Surgery Recovery and Monitoring for Restenosis

At a Glance

After choanal atresia surgery, the nasal airway can narrow again due to scar tissue, a condition called restenosis. Parents must keep the nose clean with saline and watch for signs of returning noisy breathing, feeding difficulty, or blue skin, which require prompt medical attention.

The most critical period after your child’s surgery is the healing phase. While the surgery creates a new, open airway, the body’s natural healing process can sometimes cause the new opening to narrow or close—a condition called restenosis [1]. Understanding why this happens and what signs to watch for will help you and your care team ensure long-term success.

Why Restenosis Happens

Restenosis is essentially the nose trying to “heal” itself by closing the new hole [1]. There are two main reasons this occurs:

  • Granulation Tissue: This is extra, “bumpy” scar tissue that grows over the raw areas where the surgery was performed [1][2]. If too much of this tissue grows, it can block the airway again.
  • Insufficient Bone Removal: If a piece of the vomer (the bone dividing the nose) was not removed deeply enough during the first surgery, it can act as a bridge for scar tissue to grow across, closing the gap [1][3].

Factors That Increase Risk

While every baby is different, certain factors can make a child more likely to experience re-blockage:

  • Low Weight: Babies weighing less than 5kg at the time of surgery may have higher rates of restenosis because their nasal passages are physically smaller [4].
  • Bilateral Atresia: When both sides are blocked, the surgery is more complex, and there is more “raw” surface area that needs to heal [5][6].
  • Stenting: Ironically, using plastic tubes (stents) to keep the nose open can sometimes irritate the lining and cause more scar tissue to grow [2][7].
  • Syndromes: Children with CHARGE syndrome often have more complex anatomy and unique healing patterns that require very close monitoring [8][9].

Post-Surgery Monitoring

Your care team will use several methods to ensure the airway stays open:

  • Follow-up Endoscopy: The surgeon will likely schedule regular “check-ups” where they use a tiny camera to look deep into the nose. This allows them to catch and treat small amounts of scar tissue before they become a major blockage [10][11].
  • Nasal Hygiene: Before you go home, the nursing staff will teach you how to safely use saline drops and gentle suctioning (using a specific device like a bulb syringe) to keep the area clear of mucus and crusting [12]. They will guide you on how often to perform this routine. Keeping the area clean is one of the best ways to prevent infection and promote smooth healing.
  • Steroid Injections or Dilatation: If a small amount of narrowing is found during a check-up, the doctor may use a small balloon to gently stretch the area (dilatation) or inject a steroid to slow down scar tissue growth [13].

When to Seek Immediate Help

You are the expert on your baby. You should contact your surgical team if you notice non-emergency changes such as:

  1. Recurrent “Noisy” Breathing: A return of the snoring or whistling sounds your baby had before surgery [5][14].
  2. Difficulty Feeding: If your baby starts needing to pull away from the bottle or breast frequently to take a breath [12].
  3. Persistent One-Sided Discharge: Thick mucus that consistently drains from only one nostril [14][15].

Call 911 or go to the nearest emergency room immediately if your baby experiences:

  • Cyclic Cyanosis: If your baby begins to turn blue while quiet but pinks up when crying, or shows signs of severe respiratory distress [16][17]. This is a life-threatening emergency.

While the possibility of a “revision” surgery (a second procedure) can be discouraging, catching narrowing early often means a simpler, less invasive fix can be used to keep your baby’s airway clear [18][19].

Common questions in this guide

What is restenosis after choanal atresia surgery?
Restenosis is when the newly opened nasal airway begins to narrow or close as the body attempts to heal. This is usually caused by the growth of excess scar tissue, known as granulation tissue, over the surgical site.
What are the signs that my baby's airway is narrowing again?
Signs of airway narrowing include a return of noisy breathing, whistling, or snoring. You may also notice your baby having difficulty feeding, frequently pulling away from the bottle to breathe, or having thick mucus draining persistently from one nostril.
How can I help keep my baby's nose clear after surgery?
Your nursing team will teach you how to use saline drops and gentle suctioning, typically with a bulb syringe, to clear mucus and crusting. Performing this daily hygiene routine is critical for preventing infection and promoting smooth healing in the airway.
What is cyclic cyanosis and what should I do if it happens?
Cyclic cyanosis occurs when a baby turns blue while resting or quiet, but regains a pink skin color when crying. This is a life-threatening sign of severe respiratory distress, and you should call 911 or go to the emergency room immediately if it happens.
Will my baby need another surgery if scar tissue forms?
Not necessarily. If your doctor catches the narrowing early during a routine follow-up endoscopy, they can often use a small balloon to gently stretch the area or inject a steroid to stop the scar tissue from growing further.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my child's weight and the type of blockage they had, what is their specific risk level for the airway narrowing again?
  2. 2.How often will you perform a follow-up endoscopy to check for the growth of granulation tissue?
  3. 3.If my child begins to show signs of re-blockage, is endoscopic dilatation or repeat surgery the preferred next step?
  4. 4.Can you show me how to safely perform nasal saline rinses and suctioning without damaging the healing tissue?
  5. 5.How many revision surgeries for choanal atresia have you performed this year?

Questions For You

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References

References (19)
  1. 1

    A recurrence analysis in patients with congenital choanal atresia.

    Yılmaz Topçuoğlu MS, Schuler PJ, Westhoff JH, et al.

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 2025; (53(9)):1571-1576 doi:10.1016/j.jcms.2025.07.003.

    PMID: 40628561
  2. 2

    Stented and non-stented endoscopic techniques in bilateral choanal atresia repair: A systematic review and meta-analysis.

    Chowdhury R, Almutawa D, Almutairi NK, et al.

    International journal of pediatric otorhinolaryngology 2025; (196()):112494 doi:10.1016/j.ijporl.2025.112494.

    PMID: 40701136
  3. 3

    The endoscopic transseptal approach for choanal atresia repair.

    Wormald PJ, Zhao YC, Valdes CJ, et al.

    International forum of allergy & rhinology 2016; (6(6)):654-60 doi:10.1002/alr.21716.

    PMID: 26879228
  4. 4

    Glycemic Control and Coronary Stent Failure in Patients With Type 2 Diabetes Mellitus.

    Santos-Pardo I, Andersson Franko M, Lagerqvist B, et al.

    Journal of the American College of Cardiology 2024; (84(3)):260-272 doi:10.1016/j.jacc.2024.04.012.

    PMID: 38752901
  5. 5

    Bilateral Membranous Choanal Atresia Without Associated Other Congenital Anomalies in a 16-Year-Old Female Patient: Case Report.

    Dires S, Alemayehu F, Birhanu W

    International medical case reports journal 2023; (16()):775-778 doi:10.2147/IMCRJ.S424558.

    PMID: 38020578
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    Bilateral choanal atresia diagnosed in a 3-month-old female baby: a case report.

    Abraham ZS, Kahinga AA

    Annals of medicine and surgery (2012) 2023; (85(4)):1227-1230 doi:10.1097/MS9.0000000000000484.

    PMID: 37113842
  7. 7

    Stenting versus stentless repair for bilateral choanal atresia: A systematic review of the literature.

    Gundle L, Ojha S, Hendry J, Rosen H

    International journal of pediatric otorhinolaryngology 2021; (151()):110926 doi:10.1016/j.ijporl.2021.110926.

    PMID: 34624631
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    [CHARGE syndrome in children with congenital choanal atresia].

    Kotova EN, Bogomilsky MR

    Vestnik otorinolaringologii 2022; (87(3)):7-12 doi:10.17116/otorino2022870317.

    PMID: 35818939
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    Diagnostics and therapy of bilateral choanal atresia in association with CHARGE syndrome.

    Koppen T, Bartmann D, Jakob M, et al.

    Journal of neonatal-perinatal medicine 2021; (14(1)):67-74 doi:10.3233/NPM-200450.

    PMID: 32741782
  10. 10

    Endoscopic bilateral congenital choanal atresia repair of 112 cases, evolving concept and technical experience.

    Eladl HM, Khafagy YW

    International journal of pediatric otorhinolaryngology 2016; (85()):40-5.

    PMID: 27240494
  11. 11

    [Operative technique and follow-up effect of endoscopic congenital choanal atresia and dilatation].

    Deng HY, Gao XQ, Guo YF

    Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery 2019; (33(4)):367-370 doi:10.13201/j.issn.1001-1781.2019.04.019.

    PMID: 30970412
  12. 12

    A Case Report of Late Diagnosis of Bilateral Choanal Atresia.

    ALaryani RA, Alshammari J, Alshiha WS

    Cureus 2021; (13(8)):e17530 doi:10.7759/cureus.17530.

    PMID: 34471587
  13. 13

    Management of recurrent acquired choanal atresia with radial forearm free flap transfer.

    Hirayama H, Ishida K, Kishi K, et al.

    Ear, nose, & throat journal 2024; (103(10)):NP610-NP612 doi:10.1177/01455613211070894.

    PMID: 35176899
  14. 14

    Late-diagnosed bilateral congenital choanal atresia in adulthood: a case report.

    Abboud F, Haddad S, Ibrahim G, et al.

    Journal of surgical case reports 2026; (2026(2)):rjag090 doi:10.1093/jscr/rjag090.

    PMID: 41727247
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    Bilateral Choanal Atresia in an Adolescent Female: A Rare Case Report.

    Legesse TK, Gellaw WL, Birhanu W, Zinaye A

    International medical case reports journal 2023; (16()):103-107 doi:10.2147/IMCRJ.S403272.

    PMID: 36880054
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    Congenital and Acquired Choanal Atresia: A Comprehensive Case Series on the Diagnosis and Contemporary Management.

    Gupta V, Raj P, Gupta DK, et al.

    Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2025; (77(8)):3206-3212 doi:10.1007/s12070-025-05623-0.

    PMID: 40727218
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    Congenital bilateral nasal obstruction in neonate: Case report with review of literature for congenital nasal pyriform aperture stenosis (CNPAS) and differential diagnosis and management.

    Satpathy A, Dasgupta A, Mohan NVK, Dutta C

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This page provides educational information on recovery after choanal atresia surgery. Always consult your pediatric ENT or surgical team for specific medical advice regarding your baby's healing, breathing, and daily care.

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