The most common form of nasal obstruction in neonates is soft tissue edema, but congenital bony nasal anomalies are recognized as an important cause of newborn airway obstruction. We reviewed 20 cases of congenital bony nasal abnormalties such as choanal atresia and nasal stenosis referred to National Children's Hospital between 1996 and 2001. Of the 20, 8 involved choanal atresia (6 bilateral and 2 unilateral) and 12 nasal stenosis (5 nasal cavity stenosis, 2 pyriform aperture stenosis and 5 unknown). Six cases of bilateral choanal atresia and 5 of 12 cases of the nasal stenosis presented severe airway distress. Most cases in respiratory distress required immediate surgical enlargement of nasal cavity and stenting with an endotracheal tube for 4 to 8 weeks. Of 12 with nasal stenosis, 5 with mild nasal obstruction were treated with nasal drops and 3 with mild airway distress required no treatment. Five of 7 (71%) with choanal atresia and 1 of 4 with nasal stenosis (25%) required restenosis of the nasal cavity after stent removal. Restenosis occurred more often in choanal atresia than in nasal atresia. Two of 5 with nasal restenosis required stenting for 1 to 2 months again and 1 of those was followed by stenting for more 4 months. Longer stenting did not prevent choanal from restenosis, however, no standard stenting protocol exists for neonates, highlighting the need for further study.