Congenital stenosis of the piriform aperture: Two new cases

Introduction: Congenital piriform aperture stenosis is a rare malformation of the nasal passages that is classified as a craniofacial anomaly; it may occur in isolation or as part of a genetic syndrome. Imaging, primarily computed tomography (CT), is essential for confirming the diagnosis. Management must be multidisciplinary.
Material and methods: 
Clinical Case 1: Male newborn, admitted at 11 days of age, for management of bilateral choanal atresia. A facial CT scan revealed: stenosis of the piriform aperture on the left, a narrowed appearance of the piriform aperture on the right with mixed choanal atresia on the right and bony choanal atresia on the left.
Clinical Case 2: A full-term female newborn admitted at 10 days of life for respiratory distress. A facial CT scan revealed: stenosis of the piriform aperture with bilateral stenosis of the anterior portions of the nasal fossae, predominantly on the right side.
Both patients underwent surgery involving enlargement of the piriform aperture, with satisfactory intraoperative endoscopic confirmation bilaterally. The postoperative course was uneventful. 
Conclusion: Congenital piriform aperture stenosis remains a rare condition, but its severity necessitates early diagnosis and multidisciplinary management. To ensure long-term outcomes and improve quality of life, it is essential to standardize postoperative follow-up and gain a better understanding of the genetic and pathophysiological basis of the disease.