Li et al. Journal of Medical Case Reports 2011, 5:583 http://www.jmedicalcasereports.com/content/5/1/583 Page 4 of 5 Figure 9 Posterior naris postoperation. The posterior nares were capacious on re-examine three months after the operation. cannot be diagnosed as having CHARGE syndrome. Congenital bilateral atresia of the posterior nares is a very dangerous disease which can cause death in infants because the inability to nose breathe will lead to tremendous difficulty in sucking and feeding. Mouth breathing in the long term may result in mal- formation in the midface and/or the hard palate [10]. A high-arched palate was observed in our patient. In light of Brown’s classification [5], our patient was diag- nosed as having membranous congenital bilateral choa- nal atresia. Osteoma is one common benign tumor which grows slowly in nasal sinuses. In most cases, patients do not suffer from any clinical symptoms; osteoma is found in imaging studies by accident. In general, osteoma of the paranasal sinuses occurs in the frontoethmoid region. The etiology is still unknown; however, there are three Figure 10 Ethmoid sinus postoperation. Re-examination three months after the operation. different hypothesis available suggesting that embryolo- gic, traumatic or infective factors are involved [11]. The incidence of osteoma is 62% in the frontal sinus, 24% in the ethmoid sinus, and rarely in maxillary and sphenoid sinus [12]. An osteoma in nasal sinuses can be subcate- gorized into three basic histological types: compact, can- cellous or mixed [13]. Imaging studies, especially CT and three-dimensional CT scans, are often applied for diagnoses [14]. If the osteoma does cause some discom- fort, resection is recommended. The surgical approach depends on the location and size of the tumor. A small osteoma in the ethmoid sinus can be removed under nasal endoscope. For a large osteoma, lateral rhinotomy is preferred. When an osteoma infiltrates the front cra- nial basalis, a combined craniofacial approach is usually considered [15]. Keratoleukoma is a thin, opaque, abnormal coating on the cornea of the eye. It is one kind of corneal opacity. According to the thickness of the coating, a corneal opacity is graded into corneal nebula, corneal macula and keratoleukoma. The most common causes of cor- neal opacity are ocular trauma (50.6%), retinal disease (15.5%), measles (9.5%) and congenital etiologies (5.5%) [16]. Corneal opacities vary greatly in extent and loca- tion and are usually associated with other anomalies [17], for example the bilateral congenital choanal atresia and congenital right accessory nasal deformity in our patient. Because corneal opacity is a cause of blindness [18], timely treatment is crucial. A study has shown that 64.92% of patients underwent cosmetic treatment after the primary visit [16]. Corneal transplantation should be performed when needed [19]. Conclusion Congenital bilateral choanal atresia is a life-threatening disease in newborns. However, it can also be found in adults, who may present with mouth breathing, sleep snoring and symptoms of nasal obstruction. Choanal atresia is often accompanied by other congenital abnormalities. In this case report we demonstrate the importance of clinical awareness and of general medical examination when encountering similar patients. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions XZL participated in the surgical procedure and drafted the manuscript. XLC helped in drafting the manuscript and with the critical review of the manuscript. LZ helped in drafting the manuscript. All authors read and approved the final manuscript.