Endoscopic Endonasal Repair of Bilateral Choanal Atresia in a Neonate with Placement of a Steroid-Eluting Bioabsorbable Nasal Stent (PROPEL) Using a Customised Alternative Insertion Technique: A Case Report and Literature Review

Introduction: Bilateral congenital choanal atresia (CCA) is a rare, life-threatening condition in neonates. This is the first reported case of PROPEL steroid-eluting stent use in a seven-day-old bilateral CCA neonate, with a customised technique developed to overcome limitations of the standard applicator. Case presentation: A full-term male neonate presented with severe respiratory distress and was diagnosed with bilateral CCA. Endoscopic repair with mucoperiosteal flaps and drilling of the atretic plate was performed, followed by placement of a tailored PROPEL stent using a modified insertion with a Nelaton tube system. Outcomes: Recovery was uneventful. At 30 days, the stent remained well-positioned; at two, three, and six months, the neochoana was patent with no restenosis or synechiae. Conclusions: The PROPEL stent, combined with a customised insertion method, may offer a promising alternative for neonatal CCA repair. Further studies are needed to assess long-term outcomes and safety.