Congenital bilateral choanal stresia is an uncommon anomaly of the posterior nasal choana. The etiology of this malformation is unknown ; it may be teratogenic or genetic. This entity was described over 200 years ago by Roderer. Ronaldson defined the importance in 1880 when he recognized its presence in infants coming to autopsy after dying of asphyxia neonatorum. The newborn is enable to breathe through the nose and mouth breathing is an acquired habit. Most infants can acquire mouth breathing in 3-4 or more weeks. Infants will be suffocated if the nasal airway is totally obstructed. Bilateral choanal atresia presents as an neonate emergency condition to avoid asphyxia and to establish a feeding pattern. It is urgently necessary to obtain a satisfactory nasal airway. 100 years later, the first attempt at endonasal puncture was reported by Emmert. Since then, transnasal, transantral, transseptal, transpalatal approaches have been described. The authors experienced one case of congenital choanal atresia in a 5-day-old female infant who was admitted due to dyspnea and feeding difficulty. This case was operated on using transnasal perforation with stenting for 5 weeks and the patient was discharged with good condition on the 6th hospital day. The operation result was good.