Complete Laryngotracheoesophageal Cleft: Complicated Management Issues

Abstract

Although severe laryngotracheoesophageal clefts are rare, they require prompt, team-oriented management for the best outcome possible. The diagnosis, sustenance, and treatment options of these patients depend on varied and complicated factors, which are discussed.

Management and long-term follow-up of patients with types III and IV laryngotracheoesophageal clefts

“…In addition, enteral feeding can begin in the early postoperative period, decreasing the need for parenteral nutrition and the associated complications. Microgastria has been found uniformly in our patients with type IV LTEC and has also been reported by others [9][10][11]. In these patients, the anatomic size of the stomach does not allow for adequate fundoplication to prevent reflux.…”

Acta Otorhinolaryngologica Italica

“…Signs and symptoms of LCs differ according to the severity of disease; most are respiratory in nature including chronic cough, aspiration, cyanosis and recurrent pulmonary infection associated with feeding. More serious symptoms such as severe respiratory infection and distress, stridor needing hospitalisation and even entubation as in our case are usually seen in type III and IV LCs 1 4 . Rarely, type III LCs can be misdiagnosed as asthmatic attack and treated accordingly with delayed diagnosis 5 .…”

“…There is no known prenatal diagnostic tools, and only polyhydramnios can be a non-specific finding that makes diagnosis more difficult 1 . Signs and symptoms of LCs differ according to the severity of disease; most are respiratory in nature including chronic cough, aspiration, cyanosis and recurrent pulmonary infection associated with feeding.…”

“…Type I is seen most often, while type IV was found in only 3% of cases in the series by Evans et al 3 . The mortality rate is higher than than 90% for type IV clefts 1 .…”

“…Early insult before 25 to 28 days of intrauterine life, which is the critical period for formation of TES, can cause incomplete formation of the septum. Defect in the fusion causes on-going relationship between the gastrointestinal and respiratory systems, which is the main cause of chronic cough or cyanosis during feeding and swallowing 1 .…”