Midnasal Stenosis - A Rare Cause of Congenital Nasal Obstruction

Liora Kornreich 1,4 Lirit Levi 2,4 Ohad Hilly 3,4 Eyal Raveh 2,4 Dror Gilony 2,4
1Imaging, Schneider Children's Medical Center of Israel, Israel
2ENT, Schneider Children's Medical Center of Israel, Israel
3ENT, Rabin Medical Center, Israel
4Sackler School of Medicine, Tel Aviv University, Israel

PURPOSE: Congenital nasal obstruction in the neonate may be caused by several anatomic malformations. Choanal atresia is the commonest cause, congenital pyriform aperture stenosis is a rare cause and congenital mid-nasal stenosis is an even rarer condition. The purpose of this study is to describe the clinical and imaging findings of mid nasal stenosis.

MATERIAL & METHODS: The medical charts and the imaging findings of 9 neonates with mid nasal stenosis were reviewed. On the CT scans the distance between the bony margin of the inferior turbinate and the septum was measured at the narrowest point. As a control group served 28 children who underwent CT for reasons not related to ENT problems, matched for age (0-3 months, 4-7 months, 8-12 months) and gender.

RESULTS: All 9 patients were born at full term. They presented with stertorous breathing, six of them at birth. The diagnosis was based on endoscopic examination showing mid nasal obstruction. The median time from onset of symptoms to diagnosis was 38 days. Six babies underwent CT. Two of them had unilateral choanal atresia on one side and mid nasal stenosis on the other, three had bilateral midnasal stenosis and four had unilateral stenosis. Median minimal width in the stenotic group was 1.5mm vs 3.2mm in the control group (p=0.0002). All patients were successfully managed conservatively.

CONCLUSION: Mid nasal stenosis should be included in the differential diagnosis of nasal obstruction in neonates. In contradistinction from choanal atresia and pyriform aperture stenosis, mid nasal stenosis can be treated conservatively.

Liora Kornreich
Liora Kornreich