EXTERNAL NOSE, NASAL ORIFICES AND SEPTUM 25
through the mouth, the lips close tightly again and the sequence continues.
Emergency treatment consists in the insertion pfj^ mouth airwaaLJwhich is
fixed in place to ensure respiration until curative surgery can be undertaken.
The symptoms of unilateral atresia are those of nasal obstruction including
snoring but are_slight in infancy or childhood, and are often not complained
oTTuntil later in life. Examination of the nose will show thick gelatinous
Fig. 18. Congenital unilateral atresia of the choana;
view on posterior rhinoscopy. On the left side the
normal appearances are seen. (Note the fold,
white in appearance, on the roof of the choana
on that side.)
secretion in the affected side, and no airway can be demonstrated by holding a
cold plated spatula below the nares—only the clear side steaming the plating.
Posterior rhinoscopy may be undertaken in the older child and will show the
occlusion. A probe or a soft rubber catheter cannot be passed through the
affected side into the nasopharynx. If doubt still exists radio-opaque oil may
be instilled into the suspected side of the nose, and lateral radiography will
show that it is arrested at the choana (Fig. 19).
Fig. 19. Complete choanal atresia. Lipiodol has
been injected into the nasal cavity, but none has
passed beyond the posterior border of the
Treatment of the infant with a bilateral atresia consists in perforation of the
occlusion. If this be membranous in origin perforation is easy, and the
membrane may be opened widely. If it be osseous, it must be opened by a
proof puncture trocar and cannula, or by a special instrument devised for the
purpose. The opening is widened by nibbling forceps, and when it is sufficiently
wide a plastic tube is inserted through it. The other side is treated in the same
way, and the plastic tube is brought back through this nasal cavity to the