Choanal atresia: A new embryologic theory and its influence on surgical management

Choanal atresia was first described in 1755 by Johann Roederer and continues to occur without a proven embryologic basis. Most authors have attributed the defect to persistence of the nasobuccal membrane, which leaves many unanswered questions. This paper proposes the embryologic cause to be a misdirection of the mesodermal elements originating in the neural crest cells. Recognizing this as the probable cause, 37 cases of choanal atresia are analyzed for a variety of factors, including their surgical approach and postoperative results. The clinical findings suggest the transpalatal approach offers a greater degree of success at all ages. This may be explained by the anatomic changes created by this congenital anomaly.