ARTICLE Combined Transoral-Transnasal Approach in the Repair of Congenital Posterior Choanal Atresia: Clinical Experience Mohamed Hassan, MD, Tamer AboEl-Ezz, MD, and Tamer Youssef, MD ABSTRACT Background: A myriad of techniques have been described for managing posterior choanal atresia over the years, yet no standardized surgical protocol has been established. Objective: To present our experience with the transoral-transnasal approach for repairing posterior choanal atresia. Patients and Methods: A prospective study of children with posterior choanal atresia treated at Ain Shams University Hospitals from 2006 to 2010. Thirteen children affected by this malformation underwent a transoral-transnasal approach by the authors using a standardized surgical technique. All patients were followed up for a period ranging from 6 months to 3 years. Stents were used in neonates, and topical mitomycin C was applied in follow-up when cases needed further dilatation after the first intervention. Results: Patient demographics were obtained. Stents were used in 11 cases, and mitomycin C was used in 9 cases. Complications were as follows: 1 case had palatal perforation that healed spontaneously, 2 cases had restenosis and were lost to follow-up, and of the other 11 cases, 3 needed no further management and 8 cases needed further dilatation. Conclusion: The aforementioned combined transoral-transnasal technique provides a good alternative for managing posterior choanal atresia with easier, four-handed surgery to ensure adequate posterior choana for nasal breathing, but it usually needs multiple sessions. SOMMAIRE Contexte: Un grand nombre de techniques visant a ` corriger l’atre ´ sie choanale poste ´ rieure conge ´ nitale ont e ´ te ´ de ´ crites au fil des ans, mais il n’existe aucun protocole chirurgical normalise ´a ` cet e ´ gard. Objectif: L’e ´ tude avait pour objectif de pre ´ senter notre expe ´ rience de la correction de l’atre ´ sie choanale poste ´ rieure conge ´ nitale par les voies transbuccale et transnasale. Patients et me ´ thodes: Il s’agit d’une e ´ tude prospective, portant sur des enfants atteints d’une atre ´ sie choanale poste ´ rieure et traite ´ s dans les ho ˆ pitaux de l’universite ´ Ain Shams [Caire], de 2006 a ` 2010. Treize enfants porteurs de cette malformation ont e ´ te ´ ope ´ re ´ s par les auteurs, selon une technique chirurgicale normalise ´ e, par les voies transbuccale et transnasale. Les patients ont e ´ te ´ suivis pendant une pe ´ riode variant de 6 mois a ` 3 ans. Des endoprothe `ses ont e ´ te ´ mises en place chez les nouveau-ne ´s, et des applications de mitomycine C topique ont e ´ te ´ faites pendant le suivi dans les cas ou ` une dilatation supple ´ mentaire s’imposait apre `s la premie ` re intervention. Re ´ sultats: Les donne ´ es de ´ mographiques sur les patients sont de ´ crites en de ´ tail dans l’article. Il y a eu pose d’endoprothe ` ses dans 11 cas et application de mitomycine C dans 9 cas. Les complications e ´ taient comme suit: 1 cas de perforation palatine qui s’est cicatrise ´ spontane ´ ment, 2 cas de reste ´ nose qui ont e ´ te ´ perdus en cours de suivi et, sur les 11 autres cas, 3 n’ont pas eu besoin d’autre traitement et 8 ont ne ´ cessite ´ une dilatation supple ´ mentaire. Conclusion: La double voie d’abord, transbuccale et transnasale, de ´ crite dans l’article constitue une bonne solution de rechange aux autres techniques de correction de l’atre ´ sie choanale poste ´ rieure; il s’agit d’une ope ´ ration facile, a ` quatre mains, qui vise a ` cre ´ er des choanes poste ´ rieures suffisamment grandes pour permettre la respiration nasale, mais elle ne ´ cessite ge ´ ne ´ ralement plusieurs interventions. Key words: CHARGE association, choanal atresia, mitomycin C C hoanal atresia (CA) is a failure of communication between the nasal cavity and the nasopharynx. It is an uncommon anomaly, occurring in approximately 5000 to Mohamed Hassan, Tamer AboEl-Ezz, and Tamer Youssef: Department of Otorhinolaryngology, Ain Shams University, Cairo, Egypt. Address reprint requests to: Mohamed Hassan, MD, Department of Otorhinolaryngology, Ain Shams University, Abbassia Cairo, Cairo 1771, Egypt; e-mail: gmhafez@gmail.com. DOI 10.2310/7070.2011.100126 # 2011 The Canadian Society of Otolaryngology-Head & Neck Surgery Journal of Otolaryngology-Head & Neck Surgery, Vol 40, No 3 (June), 2011: pp 271–276 271