Recent advances in the management of choanal atresia are outlined in the context of our experience at the Hospital for Sick Children, Great Ormond Street, London. Fifty cases were treated over the 6-year period 1982-1988. There was a 72% incidence of other associated congenital anomalies and 30% of patients had the CHARGE association. The advantages and pitfalls of pre-operative computerised axial tomography are illustrated. The surgical results and complications following the trans-nasal approach are discussed. Eighty-four percent of patients had their atresias successfully corrected, 12% restenosed to some extent, and 4% obliterated. The most significant complications were palatal fistulae (8%) and columella ulceration from the Portex tube stents (8%).