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Scientific Oral Presentation

Pediatric Otolaryngology

Patterns of Anterior Skull Base Ossification in Pediatric Patients Undergoing Choanal Atresia Repair

Tuesday, October 20, 2026
9:21 AM - 9:27 AM PT
Location: 409AB

    Presenting Author(s)

  • HS

    Hemali Shah, MD

    Resident Physician
    Georgetown University Hospital
    Washington, District of Columbia, United States

    • Co-Author(s)

  • JL

    James Leonard, MD

    Pediatric Otolaryngologist
    Children's National Hospital, District of Columbia, United States

  • Grace Claire Baisden, MD

    Resident
    Walter Reed
    Chevy Chase, MD, United States

  • MP

    Maria T. Pena, MD

    Professor of Otolaryngology and Pediatrics
    Children's National Hospital and The George Washington University Medical Center
    Washington, DC, United States

    • Senior Author(s)

  • Habib G. Zalzal, MD

    Assistant Professor
    Children's National Medical Center
    Washington, District of Columbia, United States

Disclosure(s):
Maria T. Pena, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Habib G. Zalzal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: To characterize anterior skull base ossification patterns in pediatric patients undergoing choanal atresia repair and assess implications for surgical planning.

Methods: A retrospective review was conducted of 34 pediatric patients who underwent surgical repair of choanal atresia at a tertiary care children’s hospital between 2008 and 2025. CT scans obtained prior to surgery were reviewed to assess ossification at key anterior skull base sites.

Results: Across the 34 patients, average age at surgery was 5.1 years (median 3.3 years). Surgical approaches included endoscopic endonasal (76%) and retropalatal with a 120-degree scope (24%). Nasal mucosal flaps were utilized in 11% of cases. Dissolvable stents were used in less than 10% of cases, while permanent stents requiring removal were used in 20.5%. Rates of restenosis and revision surgery were 61.7% and 67%, respectively. Skull base ossification was observed in 96.8% of patients at the occiput, 74.1% at the sphenoid bone, 58% at the ethmoid roof, and 58% at the orbital plates of the frontal bone. No patients demonstrated complete occiput-sphenoid or sphenoid-ethmoid roof fusion. In a subgroup analysis of 15 patients under 3 years of age, ossification rates were 96.7% at the occiput, 46.7% at the sphenoid bone, 13.3% at the ethmoid roof, and 13.3% at the orbital plates. No cerebrospinal fluid leaks were encountered in the cohort.

Conclusions: Anterior skull base ossification is frequently incomplete in children under 3 years of age, particularly at the sphenoid bone and at the junction between the sphenoid and ethmoid roof. Careful attention to skull base anatomy is required during choanal atresia repair in this age group to minimize the risk of complications.