A newborn presents with respiratory distress at rest that worsens during feeding and is relieved by crying. The infant has no nasal airway passage noted on each side by attempted passage of a 5F catheter. What is the diagnosis and embryological basis?

• A Pyriform aperture stenosis due to failure of forward growth of the nasal bones
• B Nasal dermoid cyst blocking both posterior choanae
• C Bilateral choanal atresia due to persistence of the bucconasal membrane (failure of breakdown of the oronasal membrane) ✓
• D Congenital subglottic stenosis presenting with upper airway obstruction

Explanation

Bilateral choanal atresia presents as respiratory distress at rest (since neonates are obligate nasal breathers), worse with feeding, and relieved by crying (mouth opens). It is confirmed by inability to pass a catheter through the nasal passages. The embryological basis is failure of breakdown of the bucconasal membrane (also called the oronasal membrane), which normally regresses by the 7th week of gestation to open the posterior choanae. 90% of cases have a bony component. CT is diagnostic. CHARGE syndrome should be excluded. Bilateral atresia requires urgent airway management.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.