Decannulation for infants with tracheostomy after choanoplasty.

The article presents the stages of decanulation of infants with tracheostomy with  choan atresia after a stent-free method of surgery using the upper septal flaps and fixing them with fibrin glue.

Objective: optimization, preparation, timing and prognostic factors of successful decanulation in infants after choanoplasty. Materials and methods. Study subject of 11 children under 1 year of age with tracheostomy and congenital choan atresia. The main group: children with tracheostomy after traditional choanoplasty with stents (n = 5); comparison group - children with tracheostomy admitted initially for surgery (n = 6). To assess the results of treatment, endoscopic examination, tracheobronchoscopy were used, the level of saturation with a closed tracheostomy was determined. Results. During endoscopic examination of the nasal cavity and nasopharynx in patients of group 1, decanulation is impossible due to the recurrence of the disease after choanoplasty (the size is less than 50% of the norm). All patients required stent-free choanoplasty. During catamnestic observation (1 year), no signs of restenosis were found. Successful decanulation was carried out in 9 patients at different times after surgery. In 2 patients, decanulation was delayed. Conclusion. Prolonged presence of a child on mechanical ventilation with bilateral choan atresia is unacceptable, therefore, a decision is often made to impose a tracheostomy in order to resolve respiratory failure. However, tracheostomy can occur with a large number of early and late postoperative complications, so decanulation should take place at the earliest time after nasal breathing is restored. Our proposed endoscopic approach using a vascularized mucous flap using fibrin glue is presented to us by the method of choice for choanoplasty in children with tracheostomy. The decanulation process in children even with restored nasal breathing after choana reconstruction is extremely complex and carries many risks.