Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review / Rendimiento de reparación endoscópica de atresia de coanas con colgajos endonasales. Revisión sistemática

Endoscopic repair of congenital choanal atresia is the gold standard surgical treatment today. Though several controversies on treatment have been reported, surgical techniques for better outcomes are still in discussion. The objective of this study is to evaluate the performance of endoscopic choanal atresia repair with endonasal flaps and no stents. Publications in English in the last 5 years were searched in the PUBMED database and were systematically reviewed. A total of 9 articles were included according to the inclusion criteria, obtaining a total of 266 patients managed for congenital choanal atresia with endoscopic surgery, endonasal flaps, and no stents. Surgical results, type of atresia, atresia laterality, associated pathologies and follow up were evaluated. Successful surgery was obtained in 237 (89%) patients while 29 (11%) patients required a new surgical intervention during the follow-up period. Fourteen percent of the patients were diagnosed with CHARGE syndrome and 5% of the patients had some associated heart disease. Bony-Membranous stenosis was observed in 74% of the patients, while a total bony obstruction was recognized in 26% of the patients. Unilateral atresia was observed in 37% of the cases and 63% of the cases had bilateral atresia. The mean follow-up period was 39.5 months (range 3-168 months). An important functional success rate can be accomplished by correcting congenital choanal atresia using functional endoscopic surgery, covering raw areas with endonasal vascularized flaps, avoiding postoperative endonasal stenting

La reparación endoscópica de la atresia de coanas es hoy en día el tratamiento de elección. Existen controversias con respecto a la técnica quirúrgica que aporte los mejores resultados. El objetivo de este estudio es evaluar el rendimiento de la reparación endoscópica de la atresia de coanas con uso de colgajos intranasales, sin uso de stents. Se realizó una revisión sistemática de los artículos escritos en inglés publicados en la base de datos de PUBMED en los últimos 5 años. Un total de 9 artículos cumplieron los criterios de inclusión, reuniendo 266 pacientes que fueron tratados de una atresia de coanas con técnica endoscópica con colgajos intranasales, sin uso de stents. Las variables evaluadas fueron: el tipo de atresia, los resultados quirúrgicos, la lateralidad, la enfermedad asociada y el seguimiento. En 237 pacientes (89%) se consiguió un resultado satisfactorio, mientras que 29 pacientes (11%) requirieron una nueva intervención quirúrgica durante el seguimiento. El 14% de los pacientes fueron diagnosticados de síndrome de CHARGE y un 5% tuvieron alguna cardiopatía asociada. Una estenosis óseo-membranosa fue encontrada en un 74%, mientras una estenosis totalmente ósea fue observada en un 26%. Lesiones unilaterales fueron observadas en el 37% de los casos y bilaterales en el 63% de los casos. El seguimiento medio fue de 39,5 meses (rango: 3-168 meses). Un éxito quirúrgico funcional se puede obtener usando cirugía endoscópica nasal, cubriendo las zonas de exposición ósea con colgajos nasales vascularizados y evitando el uso de stents postoperatorios

Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review.

Endoscopic repair of congenital choanal atresia is the gold standard surgical treatment today. Though several controversies on treatment have been reported, surgical techniques for better outcomes are still in discussion. The objective of this study is to evaluate the performance of endoscopic choanal atresia repair with endonasal flaps and no stents. Publications in English in the last 5 years were searched in the PUBMED database and were systematically reviewed. A total of 9 articles were included according to the inclusion criteria, obtaining a total of 266 patients managed for congenital choanal atresia with endoscopic surgery, endonasal flaps, and no stents. Surgical results, type of atresia, atresia laterality, associated pathologies and follow up were evaluated. Successful surgery was obtained in 237 (89%) patients while 29 (11%) patients required a new surgical intervention during the follow-up period. Fourteen percent of the patients were diagnosed with CHARGE syndrome and 5% of the patients had some associated heart disease. Bony-Membranous stenosis was observed in 74% of the patients, while a total bony obstruction was recognized in 26% of the patients. Unilateral atresia was observed in 37% of the cases and 63% of the cases had bilateral atresia. The mean follow-up period was 39.5 months (range 3-168 months). An important functional success rate can be accomplished by correcting congenital choanal atresia using functional endoscopic surgery, covering raw areas with endonasal vascularized flaps, avoiding postoperative endonasal stenting.

Transcanal endoscopic type 1 tympanoplasty in children: Cartilage butterfly and fascia temporalis graft.

INTRODUCTION: Endoscopic type 1 tympanoplasty is every day gaining numerous adepts for tympanic membrane repair. Due to the value of reducing postauricular approaches, decreasing postoperative morbidity and hospitalization time. The objective of this study is to present surgical results of endoscopic type 1 tympanoplasty in the pediatric population using fascia temporalis or cartilage butterfly graft. MATERIALS AND METHODS: Prospective study regarding the pediatric population, mean age of 10.7 years old. Patients diagnosed with chronic otitis media without cholesteatoma and intact ossicular chain. Tympanic membrane reconstruction using inlay cartilage butterfly graft or underlay fascia temporalis graft according to surgical needs. Audiograms were evaluated preoperatively and 6 months after surgery. No postauricular approaches were performed. RESULTS: A total of 54 ears were operated, 25 utilizing underlay fascia temporalis graft and 29 using inlay cartilage butterfly graft. Six months following surgery, dry and closed tympanic membranes were obtained in 54 cases (92.6%). Preoperative and postoperative air conduction (AC) thresholds, bone conduction (BC) thresholds and air-bone gaps (ABG) were assessed. Preoperative AC of 24.6 dB, BC of 8.9 dB and an ABG of 15.5 dB. Postoperative AC of 16.3 dB, BC of 8.9 and an ABG of 6.9 dB. A postoperative ABG reduction of 8.5 dB was reached. CONCLUSION: Transcanal endoscopic type 1 tympanoplasty can be achieved in every pediatric patient with chronic otitis media without cholesteatoma, and, is a safe and efficient procedure.