Bilateral choanal atresia is a medical emergency. With good nursing care and close observation, surgery may be delayed until it is deemed safe and there is a good chance of success. Surgical treatment of unilateral atresia is better delayed to optimize the conditions for successful surgery. There are three surgical approaches for the correction of this anomaly: transnasal, transpalatal, and trans-septal. Each has advantages and disadvantages. The patient's age is an important consideration in the choice of the technique. Partial vomer removal minimizes the likelihood of restenosis. It is widely accepted that the transnasal microsurgical technique has improved the safety and success rate in infants and younger children. The transpalatal or trans-septal approach is preferred in older children and adults.