The patient is an 18-month-old female child, born full term, by cesarean section (for cephalopelvic disproportion) with birth weight 3,750 gm to a 30-year-old primigravida. There were no immediate prenatal or postnatal medical or surgical problems in the mother. The child cried immediately after birth, there was no postnatal respiratory distress, cyanosis, or any major hospital admission. On examination, microcephaly (head circumference 46 cm below 2 standard deviation of the mean), hypertelorism, ani-Mongolian slanted eyes, left side cleft lip with high arched palate with malocclusion were observed. She presented late with c/o nasal discharge and mild breathing difficulty on breastfeeding. The catheter test revealed the diagnosis of BCCA. Noncontrast computed tomography (CT) scan nose was done, which showed nonposterior choana blocked with bony plates on both the sides (Fig. 1). The paranasal sinuses, orbit, and anterior nasal cavities were within normal limits. Transnasal endoscopic repair was done under general anesthesia. Endoscopy revealed a bony atresia (Fig. 2), which was drilled out keeping the direction medially and inferiorly. Feeding tubes were fashioned as stents and placed for a period of 6 weeks. There were no postoperative complications. The patient was referred to pediatric surgery for other problems. Endoscopy confirmed bilateral patency at 12 weeks postoperatively.

Mohindra S, Gupta AK. Bilateral Complete Congenital Choanal Atresia in an 18-month-old Female Child with Rare Clinical Presentation: Transnasal Endoscopic Repair with Stent. Clin Rhinol An Int J 2016;9(3):153-154.