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 22 peer-reviewed journal articles Updated
Pediatric Otolaryngology · Unilateral Choanal Atresia

Treatment and Surgical Strategy

At a Glance

Unilateral choanal atresia surgery is an elective procedure typically delayed until the child is older. The gold standard is transnasal endoscopic surgery, ideally using a stentless approach with mucosal flaps and adequate vomer bone removal to ensure a permanently open airway.

Because your child has unilateral (one-sided) atresia, they are able to breathe sufficiently through their open nostril [1]. This means that, unlike cases where both sides are blocked, surgery is not an immediate life-saving emergency [1][2]. Instead, this is considered an elective procedure, allowing you and your surgical team to time the operation for when your child is older [3]. The repair requires general anesthesia, so waiting until your child has grown larger and stronger makes the anesthesia safer and the post-operative healing much more manageable [3].

The Gold Standard: Transnasal Endoscopic Surgery

The current “gold standard” for repairing choanal atresia is transnasal endoscopic surgery [4][5]. In this approach, the surgeon uses a small camera (endoscope) and specialized tools to work through the nostrils, avoiding the need for external incisions on the face or mouth [4]. This method provides excellent visibility and allows for very precise work in the small nasal passages of a child [6].

Key Components of a Successful Surgery

When interviewing a surgeon, there are four specific technical aspects you should discuss to ensure the best possible outcome for your child:

1. Adequate Posterior Vomer Resection

The vomer is the thin bone that separates the two nostrils at the back of the nose [7]. One of the most common reasons for a surgery to fail is that not enough of this bone was removed [7][8]. An “adequate” vomeroplasty (reshaping this bone) creates a large, unified opening that is less likely to narrow or close as the child heals [7][9].

2. The Use of Mucosal Flaps

In the past, surgeons would often leave the bone at the surgical site “bare” to heal on its own. Today, many experts prefer to use mucosal flaps—healthy tissue taken from the inside of the nose (like the septum or the floor)—to cover the exposed bone [10][11]. These vascularized (living) flaps act like a biological bandage, promoting faster healing and significantly reducing the risk of restenosis (the airway narrowing again) [12][13][14].

3. Moving Away from Stents

For decades, it was standard practice to place plastic tubes called stents in the nose for several weeks after surgery to “hold” the airway open. However, current medical consensus is shifting away from routine stenting [15][16]. Research shows that stents can actually irritate the delicate nasal lining, causing granulation tissue (painful, bumpy scar tissue) that may lead to the very blockage the surgery was meant to fix [15][17]. Many surgeons now prefer a “stentless” approach, especially when mucosal flaps are used [18][13].

4. Additional Tools: Mitomycin-C and Coblation

Your surgeon may mention other tools used to improve success rates:

  • Mitomycin-C: A medication sometimes applied topically during surgery to slow down the cells that create scar tissue [19][20]. Note: If you look this drug up, it is primarily known as a chemotherapy medication. However, in this surgery, it is used safely in tiny, topical, single-dose applications to prevent scarring, and it does not act like systemic chemotherapy. [20][21].
  • Coblation (Low-Temperature Plasma): A technology used to remove tissue with less heat than traditional cautery [22]. This may reduce inflammation and help the area heal more quickly with less scarring [22].

Preparing for the Conversation

By asking about these specific techniques, you can evaluate whether your surgeon is using the most current, evidence-based methods to give your child the best chance at a permanent, open airway.

Return to HomePage

Common questions in this guide

When should my child have surgery for unilateral choanal atresia?
Because one side of the airway is open, the surgery is not a life-saving emergency. It is an elective procedure usually scheduled when your child is older and larger, which makes general anesthesia much safer.
What is the best surgical method for repairing the blockage?
The current gold standard is transnasal endoscopic surgery. The surgeon uses a small camera and instruments passed directly through the nostrils, which avoids the need for any incisions on your child's face or inside their mouth.
Why do surgeons use mucosal flaps during choanal atresia repair?
Surgeons use healthy tissue from inside the nose, called a mucosal flap, to cover exposed bone after the blockage is removed. This flap acts like a living biological bandage that promotes faster healing and reduces the risk of the airway narrowing again.
Will my child need to wear nasal stents after the surgery?
Many modern experts prefer a stentless approach. While plastic stents were traditionally used to hold the airway open, recent evidence shows they can irritate the delicate nasal lining and cause painful scar tissue that might block the nose again.
What is Mitomycin-C used for in choanal atresia surgery?
Mitomycin-C is a medication applied directly to the surgical site in a tiny, single dose to help prevent excessive scar tissue formation. While it is known as a chemotherapy drug, its localized, topical use in this surgery is safe and does not affect the whole body.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is your standard surgical approach for unilateral choanal atresia, and how often do you perform this procedure?
  2. 2.How much of the posterior vomer bone do you typically remove to ensure the opening stays wide?
  3. 3.Will you be using mucosal flaps to cover the exposed bone, and which specific type of flap do you prefer?
  4. 4.Do you routinely use stents after surgery, or do you prefer a stentless approach? Why?
  5. 5.Do you use any additional treatments like mitomycin-C or coblation (low-temperature plasma) to help prevent scarring?
  6. 6.What is the typical age you recommend for elective surgery in a child with a one-sided blockage?

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 (22)
  1. 1

    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
  2. 2

    Use of a modified stethoscope to assess paediatric nasal airflow in suspected choanal atresia, nasal stents or nasopharyngeal airways.

    Mason K, Royan D, Daya H, et al.

    Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2020; (45(4)):654-655 doi:10.1111/coa.13534.

    PMID: 32243067
  3. 3

    Immediate versus delayed surgery in congenital choanal atresia: A systematic review.

    Murray S, Luo L, Quimby A, et al.

    International journal of pediatric otorhinolaryngology 2019; (119()):47-53 doi:10.1016/j.ijporl.2019.01.001.

    PMID: 30665176
  4. 4

    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
  5. 5

    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
  6. 6

    [Advances in treatment of congenital posterior choanal atresia].

    Zhang J, Zhang Q, Liu D

    Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery 2016; (30(4)):342-4.

    PMID: 27373051
  7. 7

    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
  8. 8

    [Endonasal endoscopic surgery of choanal atresia - long term results].

    Holtmann L, Stähr K, Kirchner J, et al.

    Laryngo- rhino- otologie 2018; doi:10.1055/s-0044-101464.

    PMID: 29421841
  9. 9

    [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
  10. 10

    Choanal Atresia in Adult- Endoscopic Surgery and Reconstruction - A Rare Encounter.

    Sharma V, Das D, Kumar SH, et al.

    Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2025; (77(4)):1880-1883 doi:10.1007/s12070-025-05394-8.

    PMID: 40226254
  11. 11

    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
  12. 12

    [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
  13. 13

    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
  14. 14

    [Transnasal endoscopic surgery of choanal atresia after radiotherapy for nasopharyngeal carcinoma].

    Zeng L, Ye J, Luo WG, Jiang HQ

    Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 2020; (55(6)):599-603 doi:10.3760/cma.j.cn115330-20190707-00429.

    PMID: 32610403
  15. 15

    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
  16. 16

    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
  17. 17

    To stent or not to stent? A meta-analysis of endonasal congenital bilateral choanal atresia repair.

    Strychowsky JE, Kawai K, Moritz E, et al.

    The Laryngoscope 2016; (126(1)):218-27 doi:10.1002/lary.25393.

    PMID: 26014684
  18. 18

    [Choanoplasty in children of the first year of life: new opportunities and rehabilitation without stents].

    Daikhes NA, Polunin MM, Asmanov AI, et al.

    Vestnik otorinolaringologii 2024; (89(2)):40-45 doi:10.17116/otorino20248902140.

    PMID: 38805462
  19. 19

    Is mitomycin C useful as an adjuvant therapy in endoscopic treatment of laryngotracheal stenosis?

    Whited CW, Dailey SH

    The Laryngoscope 2015; (125(10)):2243-4 doi:10.1002/lary.25364.

    PMID: 26109473
  20. 20

    Use of Mitomycin C in Dacryocystorhinostomy: A Report by the American Academy of Ophthalmology.

    Freitag SK, Aakalu VK, Foster JA, et al.

    Ophthalmology 2023; (130(11)):1212-1220 doi:10.1016/j.ophtha.2023.06.024.

    PMID: 37656088
  21. 21

    [Pharmacological prevention of fibrosis in dacryosurgery].

    Atkova EL, Krakhovetskiy NN, Fokina ND, et al.

    Vestnik oftalmologii 2024; (140(2. Vyp. 2)):180-189 doi:10.17116/oftalma2024140022180.

    PMID: 38739149
  22. 22

    [Treatment of congenital bilateral choanal atresia by low temperature plasma ablation and fully degradable sinus drug stent: a case report].

    Ding Z, Yang L, Liu Y, et al.

    Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery 2024; (38(9)):879-882 doi:10.13201/j.issn.2096-7993.2024.09.020.

    PMID: 39193751

This page provides educational information about unilateral choanal atresia surgical options. It is not a substitute for professional medical advice; always consult your child's pediatric ENT surgeon to discuss the safest treatment plan.

Get notified when new evidence is published on Choanal atresia, unilateral.

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