Choanal atresia is a well-recognized congenital defect characterized by obstruction in the posterior nasal apertures, usually by bone or soft tissue, secondary to failed recanalization of the nasal fossae during fetal development (Figure 30.1). This defect was first reported by Johann George Roederer in 1755 and was later characterized as an anatomic deformity of palatine bone by Adolf Otto in 1854.1 The condition may be either unilateral or bilateral. Bilateral choanal atresia presents acutely in the neonatal period as an airway emergency, in view of the fact that neonates are obligate nasal breathers. The classic clinical scenario is one of increasing respiratory distress that improves when the child starts to cry, since he/she takes in air through the mouth, thus bypassing the obstructed choanal airway. A unilateral defect may go undetected for months or even years prior to diagnosis. Treatment may be divided into emergent and elective definitive categories and involves surgical repair of the defect. Following the first successful transnasal corrective surgery by Carl Emmert in 1854, surgical techniques have evolved from transmaxillary, transseptal, transpalatine, and sublabial intranasal approaches to modern endoscopic techniques. Despite the acceptance of the endoscopic approach as the current gold standard, controversies still exist on how to best manage patients with this condition, particularly regarding the use of adjuvant topical medications following surgical repair and the use and duration of postoperative stenting.2