From 1992 to 1996 six children and one adult woman presented at our clinic with choanal atresia. In four newborns bilateral choanal atresia was found and in two older infants and one adult unilateral atresia was discovered. Although several different techniques for management of posterior choanal atresia (PCA) are described already in the literature, we decided to try a new approach using rigid endoscopes. This techniques enables the surgeon to visualize the whole atresia plate directly and to see the tips of his instruments. Under direct view it is possible to safely remove the bony plate and to allow immediately for an adequate and persistent airway. This technique is less traumatic and minimizes the risks of conventional surgery. Follow-ups after 1, 2 and 3 years still showed remaining opening of the posterior nose and normal physical development. A second surgical intervention was necessary after 9 months in one case of a newborn however, in whom the first procedure was performed as an emergency on the second day of his life.