Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 14 peer-reviewed journal articles Updated
Pediatric Surgery

Surgical Treatment for Choanal Atresia

At a Glance

The gold standard for treating choanal atresia is transnasal endoscopic surgery. Surgeons use a tiny camera and tools to remove the nasal blockage without external cuts. Modern procedures often use a stentless approach with mucosal flaps to speed healing and prevent the airway from re-narrowing.

The goal of surgery for choanal atresia is to create a permanent, open pathway between the nose and the throat. While the timing of the procedure depends on the urgency of the baby’s breathing needs, the surgical techniques used today are designed to be minimally invasive while maximizing the chances of long-term success [1][2].

Timing and Urgency

The surgical timeline is determined by whether the blockage is on one or both sides:

  • Bilateral (Both Sides): Because this is a neonatal emergency, stabilization begins immediately with an oral airway [3]. Surgery is typically scheduled as soon as the baby is stable enough for anesthesia, often within the first few days of life [4].
  • Unilateral (One Side): Since the baby can breathe through the open side, surgery is often “elective.” Doctors may wait until the baby is older and the nasal passages are larger, which can make the surgery easier and more successful [5][6].

The Modern Surgical Approach: Transnasal Endoscopy

The “gold standard” for repairing choanal atresia is transnasal endoscopic surgery [1][7].

  • How it works: Surgeons use an endoscope—a tiny, thin tube with a camera and light—to see deep inside the nose without making any cuts on the baby’s face or the roof of their mouth [7][8].
  • Precision: Using small, specialized tools, the surgeon removes the atretic plate (the wall of bone or membrane) and a portion of the vomer (the bone that divides the two sides of the nose) [2][9].
  • Vomer Resection: Removing enough of the vomer is a critical step. Research shows that insufficient removal of this bone is a leading cause of the airway narrowing again (restenosis) later [9][10].

The Shift Toward “Stentless” Repair

In the past, it was common for surgeons to place plastic tubes called stents in the nose for several weeks after surgery to keep the new opening from closing. However, medical consensus has shifted significantly in recent years [11][12].

Current guidelines and meta-analyses suggest that stentless repair is often preferred [11][2]. The reasons include:

  • Reduced Scarring: Stents can irritate the delicate nasal lining, leading to the growth of granulation tissue (extra scar tissue), which can actually cause the nose to block up again [11][9].
  • Mucosal Flaps: Instead of using a stent, surgeons now often use mucosal flaps. This involves taking a small piece of the baby’s own nasal lining to cover the newly exposed bone [2][13]. This “living bandage” promotes faster healing and significantly reduces the risk of the passage closing back up [13][14].

Preventing Complications

To further ensure the new opening stays patent (open), surgeons may:

  • Use Topical Medications: Sometimes, a medication called Mitomycin-C is applied briefly during surgery to help slow down the formation of scar tissue [2].

By combining high-definition cameras (endoscopy) with advanced healing techniques (mucosal flaps), your surgical team aims to provide a safe and lasting airway for your baby [1][14].

Common questions in this guide

How soon does a baby need surgery for choanal atresia?
The timing of surgery depends on whether one or both sides of the nose are blocked. If both sides are blocked (bilateral), surgery is considered a neonatal emergency and is typically performed within the first few days of life. If only one side is blocked (unilateral), surgery can often be delayed until the baby is older.
What is transnasal endoscopic surgery for choanal atresia?
Transnasal endoscopic surgery is a minimally invasive procedure where surgeons use a tiny camera and thin tools inserted directly into the nose. This allows them to safely remove the blockage of bone or tissue without making any cuts on the baby's face or the roof of their mouth.
Why do many surgeons prefer a stentless repair?
Stents are plastic tubes once commonly left in the nose to keep it open after surgery. However, they can irritate the delicate nasal lining and cause extra scar tissue to form. Surgeons now often prefer a stentless approach using the baby's own tissue to cover exposed bone, which promotes faster healing.
What is restenosis and why does it happen?
Restenosis is the medical term for the newly opened airway narrowing or closing back up after surgery. This can happen if scar tissue forms or if not enough bone was removed during the initial procedure. Surgeons use specific techniques like mucosal flaps and topical medications to minimize this risk.
Will my child need a second surgery if the nose blocks up again?
Yes, if the nasal passage narrows significantly again due to scar tissue or insufficient bone removal, your child may need a second procedure to reopen the airway and restore normal breathing.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Do you plan to use a stentless approach with mucosal flaps, or is a stent necessary for my child's specific case?
  2. 2.How will the thickness of the vomer bone (as seen on the CT scan) affect how much bone you need to remove?
  3. 3.What is the risk of restenosis (re-narrowing) for my child, and what steps are taken during surgery to prevent it?
  4. 4.Will you be using an endoscope for the entire procedure, and how does that help with visualization?
  5. 5.What does the recovery process look like in the first 24 to 48 hours after surgery?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (14)
  1. 1

    Endoscopic treatment of choanal atresia and use of balloon dilation: our experience.

    De Vincentiis GC, Panatta ML, De Corso E, et al.

    Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale 2020; (40(1)):44-49 doi:10.14639/0392-100X-1567.

    PMID: 32275648
  2. 2

    Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review.

    Bartel R, Levorato M, Adroher M, et al.

    Acta otorrinolaringologica espanola 2021; (72(1)):51-56 doi:10.1016/j.otorri.2020.01.002.

    PMID: 32439138
  3. 3

    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
  4. 4

    Prognostic Factors and Management of Patients with Choanal Atresia.

    Moreddu E, Rossi ME, Nicollas R, Triglia JM

    The Journal of pediatrics 2019; (204()):234-239.e1 doi:10.1016/j.jpeds.2018.08.074.

    PMID: 30291020
  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
  6. 6

    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
  7. 7

    Treatment of Congenital Choanal Atresia via Transnasal Endoscopic Method.

    Gulşen S, Baysal E, Celenk F, et al.

    The Journal of craniofacial surgery 2017; (28(2)):338-342 doi:10.1097/SCS.0000000000003247.

    PMID: 28045821
  8. 8

    [Choanal atresia repair in Germany : Resection of dorsal septal parts and stents in focus].

    Yılmaz Topçuoğlu MS, Hammitsch-Mayer A, Plinkert PK, Baumann I

    HNO 2024; (72(3)):199-203 doi:10.1007/s00106-023-01410-x.

    PMID: 38189815
  9. 9

    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
  10. 10

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

    Moreddu E, Rizzi M, Adil E, et al.

    International journal of pediatric otorhinolaryngology 2019; (123()):151-155 doi:10.1016/j.ijporl.2019.05.010.

    PMID: 31103745
  11. 11

    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
  12. 12

    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
  13. 13

    [Nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants].

    Wang PP, Tang LX, Yang XJ, et al.

    Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 2021; (56(7)):713-718 doi:10.3760/cma.j.cn115330-20200812-00668.

    PMID: 34344097
  14. 14

    Cross-over septal flap technique for choanal atresia surgery in two centres: how I do it.

    Elhassan HA, Karligkiotis A, Searyoh K, et al.

    The Journal of laryngology and otology 2023; (137(8)):930-933 doi:10.1017/S0022215122001529.

    PMID: 36515068

This page provides educational information about surgical treatments for choanal atresia. It is for informational purposes only and does not replace professional medical advice from your child's pediatric surgeon or ENT.

Get notified when new evidence is published on Choanal atresia.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.