Author(s)
J. N. Bangiyev
M. Haupert
A. Sheyn
P. J. Thottam
Affiliation(s)
Detroit Medical Center; Children's Hospital Of Michigan; Michigan State University; St. Jude Children's Research Hospital; University Of Tennessee Health Science Center; LeBohneur Children's Hospital
Abstract:
Choanal atresia (CA) is a rare congenital cause of pediatric airway obstruction that affects between 1:5000 to 1:8000 live births. While techniques have changed significantly, surgical failure remains a common occurrence. The use of steroid eluting stents in sinus surgery has demonstrated reductions in inflammation, polyp formation, and postoperative adhesions. Our objective was to evaluate the utility of this technology in preventing restenosis and reducing need for repeat procedures in CA repair. This 3 patient case series examined the feasibility and results of choanal atresia repair utilizing the mometasone eluting stent. A newborn with bilateral CA, a 2 year old with bilateral CA and 2 failed revisions, and a teenager with unilateral CA were examined. All children underwent CA repair and mometasone eluting stent placement. All were re-evaluated at 1, 3, 6, and 9 month follow-up and findings were recorded. No complications related to stent placement or utilization was reported. Patients were re-examined at over a period of 9 months with follow-up endoscopic evaluations revealing patency of the choanae. Re-stenosis following endoscopic repair of CA is a frequent cause of treatment failure and need for additional procedures. Numerous adjunctive treatments have been utilized to minimize this complication. Traditional stenting has been scrutinized for both utility and the potential for alar necrosis. Utilizing the application of mometasone eluting sinus stents minimized scarring following endoscopic repair of choanal atresia in all patients examined without complication. The mometasone stent may provide a treatment option for primary and revision CA repair.