gms | German Medical Science

A premature infant (initial weight 2130 g) had to be delivered by caesarian sectio because of placental insufficiency. As she showed no spontaneous respiration, a nasal intubation was tried, but failed on both sides. Finally an orotracheal intubation was done. The CT and MRI scans showed a dysplasia of the vomer, that broadened like a wedge and obstructed both sides of the nasal cavity. Multiple malformations were also present, not fulfilling the criteria of the CHARGE syndrome. On the twentieth day after birth the dysmorphic vomer was resected, using an endoscope and a diode Laser, attaching the Laser glass fibre to a thin metal sucktion by adhesive tape. During the healing process no stenoses occured. Only in the central hard palate a secondary perforation occured after one week, probably as a result of circulatory disorder. It was closed by a flap forteen month later. Bilateral choanal atresias have to be treated immediately because of the severe impairment of breathing and drinking of the infant. In this case, the very small anatomical dimensions were surgically challenging. The diode Laser with it's good hemostasis and little tissue penetration proved to be a useful tool.