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Choanal Atresia and Pyriform Aperture Stenosis

Please also read the page on blocked noses.

The opening at the back of the nose is called the posterior choana. Whilst the baby is developing in the womb, that area is blocked off, but before birth the area is supposed to open up to allow the baby to breathe through the nose. The bony opening at the front of the nose (the opening that you see if you look at a skull) is called the pyriform aperture.

Pyriform Aperture Stenosis

Pyriform aperture stenosis happens when the bony opening at the front of the nose is too small. If your baby is affected, they will struggle to breathe pretty much from birth. Your ENT team will look into the nose and identify narrowing, and may recommend a scan to assess this further. Some children manage with medication designed to shrink down any swelling in the lining of the nose, but others require corrective surgery.

Choanal Atresia

Choanal atresia is blockage at the back of the nose. It can affect one side only, or both sides.

Babies with choanal atresia on both sides of the nose struggle to breathe in the delivery suite, and may go blue and stop breathing. They may require intensive care support, and will likely need surgery within the first few days of life to resolve the blockage.

One sided choanal atresia often isn't diagnosed until the child is a few years old, and is identified by parents because of constant one sided snotty nose. Again, surgery will be used to correct it, but unlike a baby with atresia on both sides that needs emergency surgery, one sided surgery can be planned without pressure.

Treatment of choanal atresia and pyriform stenosis

Surgery for choanal atresia and pyriform aperture stenosis is complex and carried out in specialist centres. After surgery, there is often some swelling in the operated area, which may make matters worse for a period of time. Your child will likely need medication to help, regular nose cleaning (nurses will tell you how), and may require plastic tubes being placed into the nose to help keep the operated area open.

Both choanal atresia and pyriform aperture stenosis can be associated with other developmental problems also.

Narrowed front of nose in pyriform aperture stenosis, seen on CT scan

Narrowed back of nose in choanal atresia on both sides, seen on CT scan

Pyriform aperture stenosis can be associated with having just one central incisor in the top teeth, rather than two