Laryngotracheoesophageal Clefts

Abstract

This article reviews laryngeal cleft anomalies from the Laryngeal Development Laboratory at Children's Memorial Hospital in Chicago and includes a discussion of the classification of laryngotracheoesophageal clefts based on previous work and the information presented herein. Of the 115 laryngeal specimens obtained between 1975 and 1995, 11 have laryngeal cleft anomalies. Eight have a submucous laryngeal cleft. There is 1 laryngotracheoesophageal cleft, type II (partial cricoid cleft); and there are 2 laryngotracheoesophageal clefts, type III (complete cricoid cleft). The histopathologic findings are presented in detail and the literature is reviewed. Photomicrographs and drawings illustrate the pathology and classification. Clinical presentation, diagnosis, evaluation, and management are discussed, as is the embryology.

Laryngotracheo-Esophageal Cleft in a Neonate with Esophageal Atresia and Tracheo-Esophageal Fistula: Report of a Case

“…Several approaches have been advocated to achieve this end. 5,6 Other reports have also described difficulties in intubation and in keeping the endotracheal tube in place in patients with LTEC, as faced by us. 5,11 In fact, in our neonate there was easy visibility of the endotracheal tube through the transparent common wall of the upper pouch which prompted us to suspect the presence of a LTEC.…”

“…5 According to one study, TEF was found to coexist in as many as 20% of patients with a cleft larynx, the majority of whom also had EA. 6 This association has been attributed to the failure of rostral development of the tracheo-esophageal septum during early embryonic life 5,7 but, contrary to expectations, laryngeal anomalies are rarely noted in neonates with EA.…”

“…Moreover, coughing, choking, regurgitation of feeds, and attacks of cyanosis are common to both conditions, 6 however, stridor and dysphonia (hoarse cry) are classically seen in neonates with LTEC although they may not be present in babies with other laryngeal anomalies. [5][6][7][8] These signs in a baby with EA should alert the attending clinician to the possibility of an associated laryngeal cleft. We attributed the weak, hoarse cry of the baby in this report to his poor general condition and therefore, a differential diagnosis of associated LTEC was not thought of preoperatively.…”

“…A combined cervicothoracic approach can be utilized once the patient's condition stabilizes, to ligate the fistula and separate the common esophago-tracheal wall. 5,6 Neonates with EA and TEF with LTEC definitely pose a great challenge to the attending surgeon, and the infrequent occurrence of these three anomalies cannot overshadow the significance of this association. A good clinical acumen and an aggressive treatment approach can give these babies a chance to survive.…”

Multiple airway abnormalities in a patient with Rothmund–Thomson syndrome

“…Type IV involves a major part of the intrathoracic tracheoesophageal wall. The severity of symptoms in children with laryngeal clefts is generally proportional to the inferior extent of the cleft [18]. Feeding difficulties and aspiration are the most common manifestations [19].…”