PMC3915069_01
Nasal hypoplasia with very small nostrils
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F1
Hospital affiliated to the University of Medical Sciences of Tabriz, Iran on the 3rd of December 2011, immediately after birth with respiratory distress due to bilateral coanal atresia and nasal hypoplasia with very small nostrils (Fig.1).
Trans-nasal dilation catheters couldn't pass through the nostrils
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F2
In the physical exam we noticed that the feeding tube sized with trans-nasal dilation catheters couldn't pass through the nostrils (Fig. 2). 
CT- Scan of bilateral choanal atresia
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F3
There wasn't any evidence of mid-nasal stenosis (Fig.3).
Sublabial approach for choanal atresia
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F4
So we decided to operate the coanal atresia via the sub-labial method using a trans-nasal dilation catheter (Fig.4) and anterior nostrils were then repaired with z plasty (Fig.5).
Postoperative photo with endotracheal tubes fixed sublabially
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F6
Following this, beveled edge number 3.5 endotracheal tubes were introduced bilaterally and fixed with sutures sublabially (Fig.6).