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A seven month-old girl with bilateral choanal atresia presented to our institution with oro-nasal fistula secondary to a previous atresia repair. Examination revealed obstruction of both choanae and the presence of a fistula located in the hard palate. Endoscopic repair of the atresia and a twolayer closure of the fistula were carried out in one sitting. Follow-up of the patient for 6 months showed patent choanae and a healed palatal fistula.