【Name】 Congenital Posterior Nasal Hole Atresia Plastic Operation for Congenital Choanal Atresia 【Indications】 (1) Any newborn with periodic dyspnea, symptoms disappear when crying, and breastfeeding difficulties. (2)Anyone who inserts a silicone tube into the nasal cavity from the anterior nasal aperture, and there is a blockage when it enters 3cm, and there is atresia of the posterior nasal aperture in the manifestation. (3) Those with bilateral posterior nasal aperture atresia, who should immediately try to remove the atresia and restore the physiological function of the nasal cavity in order to keep the airway open and prevent asphyxia. (4) Children and adults with unilateral or bilateral posterior nasal aperture atresia have been accustomed to breathing through the mouth, children should not be operated too late, because long-term open-mouth breathing will affect the child’s physical and maxillofacial development. Contraindications: Infants with very poor general condition and congenital heart disease. [Preoperative preparation] (1) first establish the oral airway, the rubber nipple can be cut at the top of the 2 holes will be placed in the baby’s mouth and fixed in the baby’s head with a cloth band, so that it is accustomed to breathing through the mouth. (2) Detailed examination of the baby’s heart condition, whether there are other congenital malformations, pay attention to the nutritional supply. (3) Check whether it is unilateral or bilateral atresia of the posterior nasal aperture. (4) If it is unilateral atresia of posterior nasal aperture, the non-atresia side can be put into nasal feeding tube. (5) Blood preparation. [Anesthesia and position] (1) Tracheal intubation is performed under general anesthesia. (2) A 1:1 000 epinephrine cotton pad was placed on the deep atretic anterior wall of the nasal cavity. 1% lidocaine with a small amount of 1:1,000 epinephrine inside was injected at the junction of the hard and soft palates to control bleeding. (3) Take the supine position, head backward extension. Surgical procedure: general anesthesia, tracheal intubation and then check the posterior nasal aperture atresia for membranous or bony closure and its thickness, and then determine the surgical method. Transnasal route method: a curved file through the nasal cavity through the atresia interval, can also be used to bite the pliers or drill to remove the atresia tissue and the posterior part of the nasal septum, in order to ensure that the perforation is clear, this method is simple and effective for the membranous closure. Osgurthorpe will be atresia of the posterior nasal aperture mucous membrane vertical incision, in the atresia of the nasal cavity surface lift, divided into internal and external 2 flaps, and then in the atresia of the nasopharyngeal cavity surface transverse incision is divided into the upper and lower 2 flaps, 4 staggered flaps are fixed, the anterior and posterior nasal aperture that is connected to the front and back of the nasal aperture into the trocar to make the flap backward, to be the mucosa is healing, the airway is established and then take away the trocar (Figure 2). For bony atresia, Bose penetrated the septum with a maxillary sinus puncture needle from the nasal cavity backward, and then enlarged the septum with a urethral probe, took the appropriate size of the plastic tube introduced into the nasopharynx through the nasal cavity, and fixed it in the nasal columella with a silk thread, and reviewed it under general anesthesia in 3 weeks, removed the plastic tube, and still enlarged the septum with the urethral probe, or used a pliers to bite and remove the surrounding bone, and made it enlarged.