Congenital choanal atresia is a challenging clinical problem requiring prompt diagnosis and intervention. The method of repair is controversial, with no technique having gained universal acceptance. Proponents of the transnasal repair must acknowledge the variability of results, especially with thick bony plates, and the technical difficulties associated with this method. Advocates of the transpalatal route must recognize the associated morbidity of this technique in the newborn. The adaptation of the endoscopic technique and the development of new powered instrumentation have significantly improved the transnasal technique so that safe controlled repair may now be accomplished in the newborn.