Nasal obstruction, when it presents in the newborn, is considered a life-threatening emergency due to the period during the first 12 weeks of life when the baby is an obligate nasal breather. Hence, a number of craniofacial conditions present early on primarily with nasal obstruction and ensuing respiratory distress. Arhinia, or the congenital absence of the nose, is the most dramatic instance of this. In addition to holoprosencephaly and craniosynostoses with midfacial hypoplasia, such as Crou-zon's and Apert's syndromes, choanal atresia can be diagnosed in the first days of life. Associated with CHARGE Association, atresia of the choanae can be difficult to correct. If the endoscopic approach fails to keep the choanae patent, however, a transpalatal approach can be used.
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