A Survivor Following Repair of Laryngotracheo-Esophageal Cleft: Lessons Learned

ABSTRACT

A survivor, following successful repair of laryngotracheo-esophageal cleft extending up to cervical trachea, is being described. The cleft was repaired with anterior laryngofissure approach, using no interposition of tissue between trachea and esophagus. The patient had an uneventful recovery, short hospitalization, and satisfactory outcome on follow-up for over 11/2 years, as of now. Optimum ventilation was achieved intra-operatively via an endotracheal tube passed through operative field, following visualization of the cleft. Postoperatively, mechanical ventilation was given via nasotracheal tube left indwelling in trachea following completion of tracheal repair. Early nutrition through enteral route was started 72 hours postoperatively by drip feeds (using infusion pump) through a soft nasogastric tube that was left indwelling following esophageal repair. This maneuver, along with positional and medical therapy, helped us to gain control over gastro-esophageal reflux that is known to be incapacitating in these patients. The authors recommend a reexamination of existing management strategies for patients with laryngotracheo-esophageal clefts and suggest that conservative approach in dealing with associated problems can help decrease morbidity in these patients.

KEYWORDS

Laryngotracheo-esophageal cleft - survivor - ventilation - gastro-esophageal reflux

REFERENCES

• 1 Lipshutz G S, Albanese C T, Harrison M R, Jennings R W. Anterior cervical approach for repair of laryngotrachesophageal cleft.  J Pediatr Surg . 1998;  33 400-402
• 2 Parsons D S, Herr T. Delayed diagnosis of a laryngotracheo-esophageal cleft.  Int J Pediatr Otorhinolaryngol . 1997;  39 169-173
• 3 Pinlong E, Lesage V, Robert M, Mercier C, Ployet M J. Type III-IV laryngotracheoesophageal cleft: report of a successfully treated case.  Int J Pediatr Otorhinolaryngol . 1996;  36 253-262
• 4 Simpson B B, Ryan D P, Donahoe P K, Schnitzer J J, Kim S H, Doody D P. Type IV larryngotracheaesophageal clefts: surgical management for long-term survival.  J Pediatr Surg . 1996;  31 1128-1133
• 5 Conlon B J, O'Dwyer T. The G syndrome/Opitz oculo-genital-laryngeal syndrome/Opitz BBB/G syndrome/ Opitz-Frias syndrome.  J Laryngol Otol . 1995;  109 244-246
• 6 Evans K L, Harris R C, Bailey C M. Management of posterior laryngeal and laryngotracheo-esophageal clefts.  Arch Otolaryngol Head Neck Surg . 1995;  121 1380-1385
• 7 Ratan S K, Ratan J. Laryngotracheo-esophageal cleft in a neonate with esophageal atresia and tracheo-esophageal fistula.  Surg Today . 2001;  31 59-61
• 8 Benjamin B, Inglis A. Minor congenital laryngeal clefts: diagnosis and classification.  Ann Otol Rhinol Laryngol . 1989;  98 417-420
• 9 Pettersson G. Inhibited separation of the larynx and upper part of the trachea from the esophagus in a newborn: report of a case successfully operated upon.  Eur J Surg Suppl (Stockh) . 1955;  110 250-254
• 10 Myers C M, Cotton R T, Holmes D K, Jackson R K. Laryngeal and laryngotracheoesophageal clefts: role of early surgical repair.  Ann Otol Laryngol . 1990;  99 98-104
• 11 Donahoe P K, Gee P E. Complete laryngotracheoesophageal cleft: management and repair.  J Pediatr Surg . 1984;  19 143-148
• 12 Ryan D P, Muehrcke D D, Doody D P, Kim S H, Donahoe P K. Laryngotracheo-esophageal cleft (type IV): management and repair of lesions beyond the carina.  J Pediatr Surg . 1991;  8 962-970
• 13 Burroughs N, Leape L L. Laryngotracheoesophageal cleft: report of a case successfully treated and review of the literature.  Pediatrics . 1974;  53 516-522
• 14 Robie D K, Pearl R H, Gonsales C, Restuccia R D, Hoffman M A. Operative straegy for recurrent laryngeal cleft: a case report and review of the literature.  J Pediatr Surg . 1991;  26 971-974
• 15 Mahour G H, Cohen S R, Woolley M M. Laryngotracheoesophageal cleft associated with esophageal atresia and multiple tracheoesophageal fistulas in a twin.  J Thorac Cardiovasc Surg . 1973;  65 223-226
• 16 Geiduschek J M, Inglis A F, O'Rourke P P, Kozak F K, Mayock D E, Sawin R S. Repair of a laryngotracheo-esophageal cleft in an infant by means of extracoporeal membrane oxygenation.  Ann Otol Rhinol Laryngol . 1993;  102 827-833
• 17 Filler R M, Forte V, Chart P. Tracheobronchial stenting for the treatment of airway obstruction.  J Pediatr Surg . 1998;  33 304-311
• 18 Donahoe P K, Hendren W H. The surgical management of laryngotracheoesophageal fistula and esophageal atresia.  Surgery . 1972;  71 363-368
• 19 Scherer L R. Peptic ulcer and other conditions of the stomach. In: O'Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG, eds. Pediatric Surgery New York: Mosby 1998: 1119-1132
• 20 Corbally M T, Fitzgerald R J, Guiney E J, Ward D, Blayney A. Laryngo-tracheo-oesophageal cleft: a plea for early diagnosis.  Eur J Pediatr Surg . 1993;  3 241-243
• 21 Pillsbury H C, Fischer N D. Laryngotracheoesophageal cleft: diagnosis, management and presentation of a new diagnostic device.  Arch Otolaryngol . 1977;  103 735-737