Twenty-one patients with choanal atresia were treated from 1969 to 1985. Follow-up of 1 1/2 to 15 years postoperatively has been obtained in 17 patients. Thirteen patients had bilateral atresia and eight had unilateral atresia. All 13 patients with bilateral atresia were operated on within the first month of life. Eighteen patients were treated transnasally and two transpalatally. Ten of 15 patients treated by transnasal puncture and dilation followed by stenting of the choanae are patent after a single procedure. Five other patients, all of whom had other associated anomalies, required secondary dilations or transpalatal repair. Our results support the effectiveness of transnasal puncture and dilatation followed by stenting of the choanae as the initial surgical procedure of choice. It may be used safely in the neonate, and is often definitive.