Choanal Atresia: Unilateral

What is unilateral choanal atresia?

Choanal atresia (say: co-ANN-ul ah-TREE-zee-ah) is a condition in which the back of the nasal passage is blocked by bone or soft tissue. The nasal passage is the route that brings air through the nose to the throat. Choanal atresia is present at birth.

In unilateral choanal atresia, only one side of the nasal passage is blocked. The baby can still breathe through the side that is not blocked.

Choanal Atresia
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Choanal atresia is a condition in which the back of the nasal passage is blocked by bone or soft tissue. Some babies have a blocked nasal passage on one side.

Your child will need surgery to open the nasal passage

A child with unilateral choanal atresia will need surgery (an operation) to open the nasal passage. This surgery can wait until the child is older. An otolaryngologist/head and neck surgeon (ear, nose, and throat doctor) will perform the surgery.

This page explains what to expect when your child is having surgery for unilateral choanal atresia and how to take care of your child after the operation.

Getting ready for the operation

Several hours before the operation, your child will need to stop eating and drinking. The doctor or nurse will tell you when your child must stop eating and drinking.

Important information

Date and time of the operation:

When you must stop feeding your child:

Other things to remember:

Your child's otolaryngology (ENT) doctor:

The doctor's phone number:

The otolaryngology (ENT) clinic nurse's number:

Your family doctor's number:

What happens during the operation

Before the operation starts, your child will have a special "sleep medicine" called a general anaesthetic. This means your child will sleep through the operation and will not feel any pain.

During surgery, the nasal passage is opened. A small plastic tube called a nasal stent is placed in the nostril to keep the nasal passage open while it is healing.

The surgery usually takes from 1 to 2 hours.

After the operation

You will be able to see your child as soon as he is fully awake. A volunteer from the surgical waiting room will bring you to see your child.

After the operation, your child will spend at least 1 hour in the recovery room, also called the Post-Anaesthetic Care Unit (PACU). Your child will then be transferred to a room on the Otolaryngology (ENT) inpatient unit. Nurses will monitor your child to make sure he is recovering well after the operation.

  • Your child will be on a monitor that helps the nurse watch his breathing.
  • Your child will have an intravenous (IV) tube in his arm until he is drinking and no longer needs IV medication.
  • If your child has pain, the doctor or nurse will give him pain medicine, either through the IV tube or as a liquid to swallow.
  • Your child will be able to drink sips of clear fluids and can eat soft foods when he is ready.
  • When your child is fully awake, he will be able to get up to go to the washroom or sit in a chair with your help.
  • Your child may have some pinkish/red fluid called mucus coming from his nostril. If the mucus is thick, the nurses will suction it with a thin plastic tube called a catheter tip.
  • A nurse will show you how to put nose drops in the nostril that has the stent in it.
  • You may sleep overnight in your child�s room.

Your child will likely be in the hospital for 1 to 3 days.

Caring for your child at home

Follow these intructions when your child goes home after the procedure.

You may give your child medicine for pain

You may receive a prescription for pain medication, before you leave the hospital. Follow the dosage instructions given to you by the pharmacist. Although these prescription pain medications can be beneficial, they are also potentially very dangerous if not used properly.

When using these medications, if you notice any changes in either breathing or level of drowsiness that concern you, stop the medication and seek medical attention. If your child is unresponsive, call 911 immediately.

Do not give your child over-the-counter medicine that may have a sedative effect (makes people sleep) while giving the prescription pain medicine. Examples of these medicines are decongestants and antihistamines. Discuss these medications with your pharmacist.

You may give your child acetaminophen (such as Tylenol or Tempra) if he has pain. Give the dose as printed on the bottle for your child's age. Do not give your child ibuprofen (Motrin, Advil, or Midol) or ASA​ (Aspirin) for two weeks after the surgery. These medications could increase your child's risk of bleeding after the operation. Check with the nurse or doctor first before giving these medicines to your child.

Give your child nose drops

Your child's nurse will give you a prescription for antibiotic nose drops before you leave the hospital. Remember to place the drops into the nasal passage around the stent. Do not put the drops in the stent.

Meals at home

Once at home, keep giving your child fluids (such as juice and soup) and soft food. If he is able to tolerate this well, he can go back to eating what he normally eats.

Bathing

Your child can have baths. Make sure to keep the nasal stent clear of tub water.

Help your child breathe more comfortably

You can use a machine called a humidifer to help your child breathe more comfortably. A humidifer makes the air moist by creating a cool mist. This helps keep the mucus in your child's nasal stent loose, so it does not become sticky and block the stent. Put it at your child�s bedside.

Activity

Check with the otolaryngology doctor before your child starts playing sports or swimming, or goes back to school or day care.

When to see the doctor after the procedure

Your otolaryngology doctor will tell you when he will need to see your child again. The otolaryngology unit will tell you the date and time for a follow-up appointment.

Your child will probably need to wear the nasal stent for about 3 months. When your child is ready, the stent will be removed in the hospital under a general anaesthetic.

When to call the doctor

Please call your child�s otolaryngology doctor, otolaryngology clinic, or family doctor right away if your child has any of the following signs after going home:

  • yellowish or green nasal discharge
  • bleeding from the nose or mouth
  • fever of 38.5�C (101�F) or higher
  • the stent falls out
  • pain that gets worse
  • vomiting (throwing up) that does not stop
  • swelling of the nose or face
  • trouble swallowing
  • trouble breathing 

If this is an emergency, do not wait. Take your child to the closest emergency department.

Key points

  • In unilateral choanal atresia, one nasal passage is blocked by bone or soft tissue. Air can pass through the other side of the nose.
  • During surgery, the nasal passage is opened. A small plastic tube called a nasal stent is placed in the nostril to keep the nasal passage open while it is healing.
  • A nurse will show you how to put nose drops in the nostril that has the stent in it.
  • Nasal stents are usually left in the nasal passage for about 3 months. When your child is ready, the stent will be removed in the hospital under a general anaesthetic.

Megan Bunch, RN, BScN

Rafat Saleemi, RN, MN

Tomka George, RN

Pauline Lackey, RN

Vito Forte, MD, FRCSC

5/7/2010

 





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