Fortis Escorts Doctors Perform Endoscopic Surgery on Premature Baby; Cure Rare Nasal Blockage

Jaipur, 14th December 2018.

In a possible first, a team of doctors here performed endoscopic surgery on a 5-day old premature baby to cure bony choanal atresia, a rare blockage in the nasal passage, that caused lack of oxygen in the body and turned him blue.

A team of multi-speciality doctors at Fortis Escorts hospital performed the crucial surgery on a baby boy born at 33 weeks and had bilateral choanal atresia, a potentially fatal condition, if left untreated. The baby had difficulty in breathing caused by the blockage and was on ventilator since birth, causing a medical emergency. The child was released 5 days after the surgery following necessary neonatal care measures.

“Soon after they are born, infants can breathe only through their nose and cannot use mouth for breathing, known as obligate nasal breathing. This operation has dual challenges – one, the blockage was bony atresia that occurs in about 30 per cent children born with choanal atresia and two, since the child was premature, so we had to be extra careful. This is possibly the first case where such an operation was performed on a premature baby – there were cases of similar operations on other babies, but they were born after full term,” says Dr. Mohan Kulahari, Sr Consultant – ENT, Fortis Escorts Hospital, Jaipur.

“Previous methods to operate on cases of choanal atresia placed a stent in the nose to create the breathing passage, which was removed after a couple of months. However, this had a chance of infection and also the blockage may relapse after the stent was removed. Endoscopic surgery does not require a stent to the placed in the nasal passage and helps perform the surgery with more precision since it is a full vision surgery. It also has a reduced chance of the blockage reappearing at any later stage. We created a wide passage and did not insert any stent or tube,” says Dr.Baljeet Singh Khanduja, Sr Consultant – ENT, Fortis Escorts Hospital,Jaipur.

Choanal atresia is a congenital disorder caused by an abnormality in the bucconasal membrane, an embryonic structure that closes the choanae and separates the olfactory organ from the oral cavity and affects 1 child in every 8000 live births. The blockage of choana can be bilateral (blockage in both nasal passages) or unilateral (blockage in only one nasal passage). The blockage can be either completely bony (30 percentcases) or composed of both bone and membranes (70 percent cases). Bilateral choanal atresia can be life-threatening and symptoms appear soon after birth while unilateral choanal atresiais more common but less serious.

Dr. Mohan Kulhari and Dr.Baljeet Singh of the ENT department of the hospital led the team. Dr. Satyen Hemrajani, Senior Consultant, Neonatology played an important role in Pre-&- Post procedure care of premature baby, Dr. Atul Gupta, Paediatric Surgeon, Dr. Rajiv Tiwari and Dr. Jyotsna Bhargav complemented the procedure with their rich experience in surgery and anaesthesiology subsequently.