A safer transnasal technique for the management of bilateral choanal atresia.

A study was undertaken on a 3.2 kilogram fresh stillborn neonate, to determine ways and means of preventing damage to the skull base. Gruber and Rosen aural specula were inserted separately into the right nostril, to determine the degree of exposure of the choana with each. The position of the surgeon was varied (septoplasty versus tonsillectomy position), to determine on which anatomical site of the choana the surgeon's field of vision was focused. The Gruber aural speculum, gave a completely, uninterrupted view of the choana. In the tonsillectomy position, the entire field of vision was focused on the choana itself, whilst in the septoplasty position, one half was focused on the choana and the other half on the roof. Since the roof is part of the skull base, damage to this area can result in serious intracranial complications, such as CSF leak and meningitis. These complications can be avoided if the surgeon uses the Gruber aural speculum for exposure and operates from a tonsillectomy position.