What is choanal atresia and pyriform aperture stenosis?

Nasal obstruction in children may be from a variety of sources.  In newborns, nasal blockage (atresia) or severe narrowing (stenosis) can lead to respiratory distress.  This is because children can breathe only through their noses for the first 6-12 weeks of life.

  • Obstruction in the front of the nasal passages is called pyriform aperture stenosis.
  • Obstruction of the posterior nasal passages is called choanal atresia/stenosis, depending on severity.

How is this evaluated?

A newborn with respiratory distress must be evaluated for all sources of obstruction.  Although choanal and pyriform aperture obstructions are the most severe, a number of other reasons such as cysts, growths, or mucosal swelling can also cause significant nasal obstruction.

Children are usually examined with a flexible telescope passed into both nasal passages accompanied by imaging with CT scans.

What treatment options are available?

Newborns with mild to moderate nasal obstruction are often managed with close observation and medications to keep the nose as open as possible.

A severe blockage typically requires surgery.

  • For pyriform aperture stenosis, the surgery is done under the upper lip
  • Choanal atresia surgery is usually done through the nasal passages, but can require an incision through the roof of the mouth if the obstruction is exceptionally severe.

During the first year of life, children grow quickly and as a result, most  forms of nasal obstruction spontaneously improve with enlargement of the nasal passages.

PENTA advocates a conservative approach to nasal obstruction because of this very fact, and reserves surgery for the most severely affected children.

For more information about nasal obstruction, please contact us at 404-255-2033.