Unilateral choanal atresia first diagnosed in adulthood and repaired via endoscopic posterior septectomy—a case series and review of the literature

Choanal atresia (CA) occurs in 1:5,000–1:8,000 live births and may be unilateral or bilateral. In unilateral cases, diagnosis is most frequently made in early childhood. Rarely, however, the diagnosis may be missed and not identified until adulthood. Currently there is no clear consensus in the literature regarding the optimal approach to surgical management of unilateral CA in the adult population. Four cases of unilateral CA diagnosed in adulthood are presented. All patients suffered from longstanding unilateral rhinorrhoea, with ipsilateral nasal obstruction. Diagnosis was confirmed on nasendoscopy and computed tomography and all patients underwent surgical repair. Following repair incorporating an endoscopic assisted posterior septectomy, all patients achieved long-term clinical and anatomical choanal patency. The literature is reviewed, examining the operative factors that contribute to successful clinical outcomes. Unilateral CA presenting in adulthood is rare, with little consensus on the optimal surgical approach to repair. To the best of our knowledge this is the largest case series of previously undiagnosed adults managed via endoscopic posterior septectomy in the literature. Each patient achieved durable clinical and anatomical patency following an endoscopic assisted posterior septectomy. Further studies are required to elucidate the roles of choanal splinting, mitomycin C, and differing post-operative care regimens.