This post is going to be quite expository, educating and entertaining at the same time. Although it's a bit scientific and medically inclined, I shall try to break it down for the benefit of those who are not in the medical field.
I am undergoing a medical training in University of Nigeria Teaching Hospital, Enugu. We had this cute baby with a congenital abnormality known as bilateral choanal atresia. So I shall take us on what choanal atresia is all about.
WHAT IS BILATERAL CHOANAL ATRESIA?
Choana is an opening at the posterior part of the nasal cavity. When you breath in air, it enters from your nostrils(the outer opening of your nose) pass through the choana and enters into your larynx from where it gets into the lungs through the trachea and bronchioles. When the baby is developing in the womb, the choana is usually covered by bony or cartilaginous tissues. With time, regression of this bony or cartilaginous tissue occurs thereby making the choana patent(creating the opening). Atresia is said to occur when this bony or cartilaginous tissue covering the choana fails to regress. Thus the baby is born with a blocked choana. As a result, air cannot pass through the nose into the larynx and then to the lungs. Therefore the baby cannot take in oxygen for survival. This congenital abnormality can occur in one or both nostrils. If it occurs in one, it's called unilateral atresia. It can be right-sided or left-sided unilateral atresia(depending on the side). Right sided choanal atresia is more common than left-sided. If it involves both sides of the nostrils, it is called bilateral choanal atresia. It can also be classified based on the nature of tissue causing the atresia. Thus, we can have cartilaginous choanal atresia(covered by cartilage) or bony choanal atresia(covered by a bone). In rare cases of bilateral choanal atresia, the atresia in one nostril can be bony while the other is cartilaginous.
Source: pinterest.net
Choanal atresia occurs more in females than in males.
HOW TO KNOW IF A BABY HAS CHOANAL ATRESIA
You may not know immediately if a baby has a unilateral choanal atresia. This is because one nostril is still patent and the baby can breath well with it. However, as the baby grows, there will be slight discomfort and irritation coupled with difficulty in breathing especially when the child has upper respiratory infections or allergies. The child also will tend to have more of unilateral nasal discharge. Anything affecting the patent nostril will make breathing difficult for the child.
Source: medindia.net
Bilateral Choanal atresia is an emergency. It requires urgent attention and prompt treatment as it may lead to death of the baby. New borns are obligate nose breathers. This means that they can only breathe through the nose for the first few weeks of their lives. This is unlike adults; we can breathe through our mouth when we have nasal blockage. A baby with bilateral choanal atresia will have most of these Symptoms:
Cyanosis: On a normal, a new born should be pinkish in colour few minutes/hours after birth. However, a baby with bilateral choanal atresia will be bluish in colour especially while sleeping or feeding. This condition is known as cyanosis. It occurs as a result of absence or low oxygenation of tissues.
Difficulty in Breastfeeding: The baby will tend to choke while suckling. The mother will notice a form of restlessness and discomfort whenever the baby tries to feed.
Frequent Crying : A baby with this condition will only take in oxygen through the mouth when it cries. So these babies tend to cry often than those without the condition.
In addition to the above, there will be obvious respiratory distress and irritability.
HOW TO INVESTIGATE A CHILD WITH CHOANAL ATRESIA
Investigation means carrying out tests to confirm your suspicion that the baby has choanal atresia. A skillful medical practitioner will try pass a soft plastic tube through the nasal cavity into the pharynx. If there's atresia of the choana, the tube will not pass.
Computer tomographic Scan(CT Scan) and/or Magnetic Resonance Imaging(MRI) may be done to confirm the diagnosis. They will show the blockage of the choana. In order not to expose the child to radiation, some doctors may may prefer MRI.
HOW TO TREAT CHOANAL ATRESIA
Choanal atresia is treated most times by surgery. This surgery is known as choanoplasty.
In unilateral choanal atresia, nasal spray can be used to keep the non-atresic nostril patent. Surgery may be indicated to remove the atresia.
In bilateral choanal atresia, the doctor may save the life of the child by first performing a tracheostomy. During tracheostomy, the anterior part of the neck is slightly cut open and a tube is inserted into the trachea. This tube delivers oxygen from the environment to the trachea and hence into the lungs. This is an emergency procedure aimed at keeping the baby alive pending when choanoplasty, the definitive surgery would be done.
During choanoplasty, the surgeons remove the tissues covering the choana. This can be done through the nose or through the mouth. After the removal, they put a stent(a soft tube) through the openings and leave it for about 6 to 8 weeks. This is to ensure the opening does not close again when granulation tissues begin to form. Granulation tissues are responsible for healing to occur and they finish forming around 6 weeks.
Source:Pinterest.com
So we first did tracheostomy for our patient when we noticed he had bilateral choanal atresia immediately after birth. At the fourth day, we prepared him for bilateral choanoplasty. It took us four hours to finish the surgery. To the glory of God, it was a success. The baby is hale and hearty now without any form of other health issues.
CONCLUSION
Choanal atresia is a common congenital abnormality involving the nose. It can lead to the death of a baby if it involves both nostrils. However, with careful observation and expertise, such a baby should not die from it. The atresia can be removed by surgery and the baby will live his or her normal life again.
It is important to state at this point that choanal atresia occurs sometimes with other abnormalities such as:
CHARGE syndrome: an abnormality that presents with hearing loss, vision loss and difficulty in swallowing.
Crouzon Syndrome: This is an abnormality that causes the baby's skull to fuse earlier than it should. The bones of the skull fail to grow to their normal size.
Tessier Syndrome: This causes the baby to have facial clefts. Clefts are abnormal openings occurring as a result of failure of structures that should appose in the womb .
Genital hypoplasia: Inability or improper development of the vagina in girls or penis in boys.
So in essence, a baby with choanal atresia should be checked for other abnormalities
REFERENCES
Lecture note on congenital abnormalities of the nasal cavity by Dr A. Orji. UNTH, Enugu. 2018
Norman S. Williams et. al. Bailey and Love's Short Practice of Surgery. 26th edition. CRC Press: London.
Choanal Atresia: Bilateral and Unilateral Type, Symptoms, Treatments. Retrieved from
https://www.healthline.com/health/choanal-atresia on 5/5/2018
Choanal atresia: Medlineplus Medical Encyclopedia. Retrieved from
https://medlineplus.gov/ency/article/001642.htm on 5/5/2018.
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