Choanal Atresia (Differential Diagnosis RDS)

atno_20a_n.jpg: Drawing of a sagittal section through the anterior basal fossa, nasal and oral cavity of a newborn (the frontal and sphenoidal sinus are not yet developed in this agegroup but depicted for didactic reasons by M. Bettex). In the most posterior part of the nasal cavity the lumen is closed by an osseous bridge between the hard palate and the skull base. atno_20b_n.jpg: Operative findings with a view of the hard palate. The periosteum is divided in the midline including the soft palate and the uvula, and retained on the right side by a suture, and on the left side by a retractor. On the left side of the patient the most posterior part of the hard palate has been opened by a drill, and the osseous connection to the base of the skull removed. atno_20a_n.jpg: A relatively rare cause of a life-threatening respiratory distress syndrome in the newborn is a bilateral osseous or fibrous choanal atresia. It leads to a paradoxical cyanosis which means that some air is entering the lung during crying and the newborn gets rosy, and cyanotic in between. atno_20b_n.jpg: Following intubation of the newborn, stabilization, and exclusion of severe combined malformations, surgery should be performed as quickly as possible; a transpalatinal opening of the choana is a uselful and safe method.