Konjenital Koanal Atrezide Bilgisayarlı Tomografi Bulguları

Öz

Amaç: Konjenital koanal atrezi nazal kavite ve nazofarenks arasında açıklığı sağlayan posterior koananın, unilateral veya bilateral olarak total obstrüksiyonudur. Bu çalışmada, bu tip olgularda bilgisayarlı tomografi bulgularını araştırmak ve analiz etmek amaçlanmıştır.Gereç ve Yöntemler: Hastanemizde 2005-2013 yılları arasında kongenital koanal atrezi tespit edilen ve radyoloji bölümümüzde kontrastsız nazofarinks bilgisayarlı tomografisi ile incelenen 30 hasta (1gün - 1 yaş, ort 14 gün; 21:K, 9:E) çalışmaya dahil edildi. Olguların bilgisayarlı tomografi görüntüleri ve medikal bilgileri ‘Picture Archiving and Communications System’ üzerinden retrospektif olarak değerlendirildi.Bulgular: Otuz olgunun 17’sinde (%57) bilateral, 13’inde (%43) unilateral konjenital koanal atrezi izlendi. Yedi olguda (%23.3) membranöz, 7 olguda (%23.3) miks,16 (%53.3) olguda kemik tip atrezi saptandı. Unilateral olguların 7’sinde (%54); bilateral olanların 12’sinde (%70) kardiyak ve kraniyofasiyal anomaliler başta olmak üzere eşlik eden konjenital anomali saptandı. Olguların %33’ünde (6 bilateral, 4 unilateral olguda) CHARGE Sendromu mevcuttu. Geriye kalan olguların 7’sinde başka sendromlar tespit edildi.Sonuç: Bizim serimizde koanal atrezi daha çok kemik tipte ve bilateral olarak izlenmiştir. Diğer konjenital anomaliler özellikle bilateral tipte sıklıkla eşlik etmektedir. Bilateral konjenital koanal atrezi zorunlu nazal solunum yapan yenidoğanda medikal bir acildir. Bilgisayarlı tomografi koanal atrezide tanının doğrulanmasında, tipinin belirlenmesinde, diğer nazal kavite obstrüksiyonu nedenlerinin saptanmasında etkili, değerli ve kolay ulaşılabilir bir yöntemdir.

Anahtar Kelimeler

• Anomaliler, CHARGE Sendromu, Koanal, Koanal atrezi, Nazal

Computed Tomography Findings in Congenital Choanal Atresia

Öz

Objective: Congenital choanal atresia is the total unilateral or bilateral obstruction of posterior choanae that connect the nasal cavity with the nasopharynx. The aim of this study was to investigate and analyse the computed tomography findings in such cases.Material and Methods: Computed tomography images and medical records of 30 children (21F: 9M, age range 1 day to 2 years, mean age 14 days) diagnosed with congenital choanal atresia between 2005 and 2013 were retrospectively reevaluated by using the Picture Archiving and Communications System.results: Among 30 congenital choanal atresia cases, 17 (57%) were bilateral and 13 (43%) were unilateral. There were 7 (23.3%) membranous, 7 (23.3%) mixed and 16 (53.3%) bony atresia cases. Associated congenital anomalies were found in 54% of unilateral and in 70% of bilateral cases. At least four of the six criteria of the CHARGE association were present in 6 of the bilateral and 4 of the unilateral cases (total 33%). conclusion: Choanal atresia was found to be more commonly bilateral and usually of the bony type in our series. Other congenital anomalies were found to frequently accompany congenital choanal atresia, especially when bilateral. Computed tomography is a valuable and easily accessible diagnostic tool and should be the modality of choice to evaluate neonates with nasal obstruction

Anahtar Kelimeler

• Anomalies, CHARGE Syndrome, Choanal, Choanal atresia, Nasal

Kaynakça

1. Petkovska l, Petkovska I, Ramadan S, Aslam MO. CT evaluation of congenital choanal atresia: Our experience and review of the literature. Australas Radiol 2007;51:236-9.
2. Slovis Tl, Eggli DF. Congenital anomalies and acquired lesions. In: Jerald P Kuhn; Thomas l. Slovis, Jack O. Haller, (editors). Caffey’s Pediatric Diagnostic Imaging, Volume 1. 10th ed. uSA: Elsevier, 2004;22-28.
3. Slovis Tl, Renfro B, Watts FB, Kuhns lR, Belenky W, Spoylar J. Choanal atresia: Precise CT evaluation. Radiology 1985;155: 345-8.
4. Jones JE, Young E, Heier l. Cogenital bony nasal cavity deformities. Am J Rhinol 1998;12:81-6.
5. Jonniaux E, Brihaye P, Bernheim n, Mansbach Al. Apertura pyriformis stenosis in the newborn. B-EnT 2006;2:31-3.
6. Bignault A, Castillo M. Congenital nasal piriform aperture stenosis. AJnR Am J neuroradiol 1994;15:877-8.
7. Tadmor R, Ravid M, Millet D, leventon G. Computed tomographic demonstration of choanal atresia. AJnR Am J neuroradiol 1984;5:743-5.
8. Brown OE, Pownell P, Manning SC. Choanal atresia: A new anatomic classification and clinical management applications. laryngoscope 1998;106:97-101.

9. Hsu CY, li YW, Hsu JC. Congenital choanal atresia: Computed tomographic and clinical findings. Acta Paediatr Taiwan 1999;40:13-7.
10. Rombaux P, Hamoir M, Gilain V, Verellen G, Debauche C, Clapuyt P, et al. Choanal atresia: A retrospective study of 39 cases. Rev laryngol Otol Rhinol (Bord) 2001; 122:147–54.
11. Gujrathi CS, Daniel SJ, James Al, Vito F. Management of bilateral choanal atresia in the neonate: An institutional review. Int J Pediatr Otorhinolaryngol 2004;68:399–407.
12. Morimoto AK, Wiggins RH 3rd, Hudgins PA, Hedlund Gl, Hamilton B, Mukherji SK, Telian SA, Harnsberger HR. Absent semicircular canals in CHARGE syndrome: Radiologic spectrum of findings. AJnR Am J neuroradiol 2006;27:1663-71.
13. Chakraborty S, Chakraborty J. CHARGE association. Indian J Endocrinol Metab 2012;16:501–3.
14. Rejjal A, Alaiyan S, Coates R, Abuzeid M. The prevalence and spectrum of brain abnormalities in congenital choanal atresia. neuropediatrics 1994;25:85-8.