16- day old neonate suffering from a rare congenital abnormality undergoes successful lifesaving surgery at Zulekha Hospital, Sharjah

It is a rare condition, occurring in approximately 1 in 10,000 live births, and is seen more often in females than in males

Zulekha Hospital, Sharjah, Rare congenital abnormality, Endoscopic repair, Tamer Mohamed Attia, Hospital Zoe, Consultant Otolaryngologist, Abhijit Sen, NICU

Zoe Margarette underwent a successful Endoscopic repair of bilateral choanal atresia at 16 days of age at Zulekha Hospital, Sharjah on 2nd February 2020. Zoe was born in a hospital in Fujairah, presented to have cyanosis during resuscitation at the time of birth, a condition that leads to bluish discoloration of the skin due to shortage of oxygen in the blood. While cyanosis can be caused by a variety of reasons more commonly related to heart and lungs, however, the doctors’ confirmed that she had bilateral choanal atresia after performing a CT scan.
Choanal atresia is a congenital disorder where the back of the nasal passage is blocked, usually by abnormal bony or soft tissue, which restricts the air to pass into the airway. In bilateral choanal atresia both nasal passages are blocked.
It is a rare condition, occurring in approximately 1 in 10,000 live births, and is seen more often in females than in males.

Dr Tamer Mohamed Attia, Consultant Otolaryngologist added: “Bilateral choanal atresia is a serious life-threatening medical emergency because the babies are obligate nasal breathers (they only use their noses to breathe in the first 3 months of their life). While the cause of the condition is not well determined, genetic abnormalities could be a major reason.” 

At the first hospital Zoe was admitted to, an endotracheal tube (a flexible plastic tube placed through the mouth into the windpipe) was inserted to help her breathe as an immediate measure. From then until further investigations confirmed the condition of Zoe, she received feeding and breathing support in NICU and was referred to Zulekha Hospital Sharjah for definitive management through surgical means.

“While the baby’s life could be saved through the maintenance of temporary airway, we cannot continuously keep the baby on endotracheal tube as they need to be fed,” stated Dr Abhijit Sen, Specialist Anesthetist.    
The two and a half hour surgery involved complete repair of atresia by removing the atretic plate and removal of the posterior one third nasal septum, to make a common nasal opening for both nostrils to eliminate chances of reformation of the atretic plate.

“To minimize the risks of postoperative complications, we used a unique endoscopic technique called nasal septal crossover flap technique where the bones at the area with excisions are not left exposed and covered with mucosal flaps. This became possible with only the modern endoscopic micro surgical instruments and the state of the art facilities we have in our hospital “added Dr. Attia.