Type IV laryngotracheoesophageal cleft repair by a new combination of lateral thoraco-cervical and laryngoscopic approaches

Abstract

Type IV laryngotracheoesophageal cleft (LTEC) is a rare congenital anomaly that is associated with high morbidity and mortality despite various forms of surgical repair. This article presents our strategy for surgical management of type IV LTECs using a combination of lateral thoraco-cervical and laryngoscopic approaches.

Our experience in two cases of type IV laryngotracheoesophageal cleft (LTEC) with a diagnosis of antenatal esophageal atresia

“…In the meantime, the patient could not be well oxygenated, although an effective intubation was performed with right and left endotracheal intubation intraoperatively. Repair with cardiopulmonary by-pass or extracorporeal mebrane oxygenation(ECMO) that are recommended during the surgery of these kinds of patients was not preferred owing to the complications the patient would go through along with technical difficulties and the littleness of the patient [1, 2, 6, 7]. Even though the two incisions made to the cleft anteriorly and laterally during anterior approach are sufficient for the development of new trachea and esophagus, separation of the trachea and esophagus are difficult in cases like ours where the cleft extends to the tracheal carina.…”

“…While congenital laryngeal anomalies are seen one in every 2000 live births, less than 0.3% of these are LTECs [1]. Laryngeal clefts are classified as type 1: supraglottic interarytenoid cleft; type II: partial cricoid cleft extending below the level of the vocal folds; type III: total cricoid cleft that may extend to the cervical tracheoesophageal septum; and type IV: laryngoesophageal cleft involving a major part of the tracheoesophageal wall in the thorax [2].…”

“…Laryngeal clefts are classified as type 1: supraglottic interarytenoid cleft; type II: partial cricoid cleft extending below the level of the vocal folds; type III: total cricoid cleft that may extend to the cervical tracheoesophageal septum; and type IV: laryngoesophageal cleft involving a major part of the tracheoesophageal wall in the thorax [2]. Out of these, types III and IV are the most challenging to diagnose and manage since they are life-threatening conditions [1, 2]. It was our aim with these case reports to report our clinical experience in two cases diagnosed with Type IV LTEC.…”