Exomphalos and Type IV Laryngeal Cleft: A Surgical Challenge

Introduction

A newborn infant was diagnosed with a giant exomphalos and a type IV laryngotracheoesophageal cleft (LTEC). Both disorders are associated with a high mortality and morbidity. Gastro-oesophageal reflux is common in patients with a cleft. The surgical challenges for fundoplication and gastrostomy included a shortened oesophagus, microgastria and abdominal wall mesh repair. Despite the complexities of this case, the infant continues to thrive.

References

• 1 Benjamin B, Inglis A. Minor congenital laryngeal clefts: diagnosis and classification.  Ann Otol Rhinol Laryngol. 1989;  98 417-420
• 2 Cotton R T, Schreiber J T. Management of laryngotracheoesophageal cleft.  Ann Otol. 1981;  90 401-405
• 3 DuBois J J, Pokorny W J, Harberg F J. et al . Current management of laryngeal and laryngotracheoesophageal clefts.  J Pediatr Surg. 1990;  25 855-860
• 4 Evans J NG. Management of the cleft larynx and tracheoesophageal clefts.  Ann Otol Laryngol. 1985;  94 627-630
• 5 Kawaguchi A L, Donahoe P K, Ryan D P. Management and long-term follow-up of patients with types III and IV laryngoesophageal clefts.  J Pediatr Surg. 2005;  40 158-165
• 6 Lipshutz G S, Albanese C T, Harrison M R. et al . Anterior cervical approach for repair of laryngotracheoesophageal cleft.  J Pediatr Surg. 1998;  33 400-402
• 7 Mathur N N, Peek G J, Bailey C M. et al . Strategies for managing type IV laryngotracheoesophageal clefts at Great Ormond Street Hospital for Children.  Int J Pediatr Otorhinolaryngol. 2006;  70 1901-1910
• 8 Moukheiber A K, Camboulivess J, Guys J M. et al . Repair of a type IV laryngotracheoesophageal cleft with cardiac bypass.  Ann Otol Rhinol Laryngol. 2002;  111 1076-1080
• 9 Robie D K, Pearl R H, Gonsales C. et al . Operative strategy for recurrent laryngeal cleft: a case report and review of the literature.  J Pediatr Surg. 1991;  26 971-974
• 10 Ryan D P, Muehrcke D D, Doody D P. et al . Laryngotracheoesophageal cleft (type IV): management and repair of clefts beyond the carina.  J Pediatr Surg. 1991;  26 962-970
• 11 Shehab Z P, Bailey C M. Type IV laryngotracheoesophageal clefts – recent 5 year experience at Great Ormond Street Hospital for Children.  Int J Pediatr Otorhinolaryngol. 2001;  60 1-9
• 12 Simpson B B, Ryan D P, Donahoe P K. et al . Type IV laryngotracheoesophageal clefts: surgical management for long term survival.  J Pediatr Surg. 1996;  31 1128-1133
• 13 Tsakayannis D E, Zurakowski D, Lillehei C W. Respiratory insufficiency at birth: a predictor of mortality for infants with omphalocele.  J Pediatr Surg. 1996;  31 1088-1090