The indications for surgery of congenital choanal atresia and the different surgical approaches are discussed in detail. The transnasal approaches should be done only in emergency situations or as first-aid treatment; the transmaxillary approach is not important today. The transpalatinal approach in the head-down position under microsurgical conditions has proved to be much better. Thirty-six cases with congenital choanal atresia were observed in 15 years. Thirty-four patients were operated on in infancy or childhood and controlled later on. Four children showed bilateral choanal atresia; the other patients had unilateral complete atresia. In 8 patients a transnasal approach was done, in 6 cases there was a recurrence in the form of a complete stenosis and after transpalatinal re-operations there was a relapse in only one case. One patient was operated on the transmaxillary approach. In 25 cases the transpalatinal approach was the method of operation; relapse was seen in 5 cases only and could be revised by transpalatinal approach, one case excepted. Own experience and the present results show that the transpalatinal approach is suitable for adults as well as newborn babies and infants. On account of the better view of the operating area and optimal reconstructive conditions, the transpalatinal approach appears to be safer and long-term results are good.