Endoscopic Laryngotracheal Cleft Repair Without Tracheotomy or Intubation

Sandu, Kishore; Monnier, Philippe

doi:10.1097/01.mlg.0000200794.78614.87

Cited by 67 publications

(53 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To date, the Benjamin and Inglis classification [7], modified by Sandu in 2006 [8], are the most frequently used (Figure 2). Indeed, they differentiate partial and total cleft of the cricoid cartilage, as well as cervical and tracheo-thoracic cleft.…”

Section: Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Laryngo-tracheo-oesophageal clefts

Leboulanger

Garabédian

2011

Orphanet Journal of Rare Diseases

View full text Add to dashboard Cite

A laryngo-tracheo-esophageal cleft (LC) is a congenital malformation characterized by an abnormal, posterior, sagittal communication between the larynx and the pharynx, possibly extending downward between the trachea and the esophagus. The estimated annual incidence of LC is 1/10,000 to 1/20,000 live births, accounting for 0.2% to 1.5% of congenital malformations of the larynx. These incidence rates may however be underestimated due to difficulty in diagnosing minor forms and a high mortality rate in severe forms. A slightly higher incidence has been reported in boys than in girls. No specific geographic distribution has been found. Depending on the severity of the malformation, patients may present with stridor, hoarse cry, swallowing difficulties, aspirations, cough, dyspnea and cyanosis through to early respiratory distress. Five types of laryngo-tracheo-esophageal cleft have been described based on the downward extension of the cleft, which typically correlates with the severity of symptoms: Type 0 laryngo-tracheo-esophageal cleft to Type 4 laryngo-tracheo-esophageal cleft. LC is often associated with other congenital abnormalities/anomalies (16% to 68%), mainly involving the gastro-intestinal tract, which include laryngomalacia, tracheo-bronchial dyskinesia, tracheo-bronchomalacia (mostly in types 3 and 4), and gastro-esophageal reflux disease (GERD). The syndromes most frequently associated with an LC are Opitz/BBB syndrome, Pallister Hall syndrome, VACTERL/VATER association, and CHARGE syndrome. Laryngeal clefts result from failure of fusion of the posterior cricoid lamina and abnormal development of the tracheo-esophageal septum. The causes of the embryological developmental anomalies leading to LC are not known but are thought to be multifactorial. LC appears to be mostly sporadic although some familial cases with suspected autosomal dominant transmission have been reported. The age of diagnosis depends mainly on the severity of the clinical symptoms and therefore on the extent of the LC. Diagnosis is made either based on clinical manifestations or on investigations, such as endoscopy, X-ray, CT scan, performed for other conditions. Differential diagnoses include tracheo-bronchial fistula, gastro-esophageal reflux disease and neurological swallowing disorders, as well as laryngomalacia and laryngeal palsy. Prenatal diagnosis of LC has never been reported, although associated anomalies may be detected on fetal ultrasonography. Once the cleft is diagnosed, it is essential to determine its length to orient the management and treatment approach. Management involves maintenance of satisfactory ventilation, prevention of secondary pulmonary complications as a result of repeated aspirations, and adequate feeding. Endotracheal intubation may be required for respiratory distress in severe cases. Treatment requires endoscopic or external surgery to close the cleft. Surgery should be performed as early as possible to avoid complications related to aspiration and gastric reflux, except in type 0 and type 1 cases in ...

show abstract

Section: Reviewmentioning

confidence: 99%

“…Since its early beginning in the 1980's, numerous publications have described the endoscopic technique for the closure of type I and type II LC [8,29,41,55,58,60,63,64]. Recently, successful cases of endoscopic closure of type III clefts have also been reported [58,60].…”

Section: Reviewmentioning

confidence: 99%

Laryngo-tracheo-oesophageal clefts

Leboulanger

Garabédian

2011

Orphanet Journal of Rare Diseases

View full text Add to dashboard Cite

show abstract

“…Recently, there have been reported endoscopic repair of LTEC's [15,16]. The patients were mainly types I or II in the study from Boston and IIIa (extending through the cricoid but not involving the trachea) or IIIb (extending into the cervical trachea only).…”

Section: Discussionmentioning

confidence: 97%

Surgical management of type III and IV laryngotracheoesophageal clefts: The three-layered approach

Geller

Kim²,

Koempel

et al. 2010

International Journal of Pediatric Otorhinolaryngology

View full text Add to dashboard Cite

“…It is well known that grade 1 and 2 clefts can be successfully corrected endoscopically, and few cases of endoscopic treatment of grade 3 cleft have been reported [8,9]. However, the cleft relapsed in 50% of these cases [8], therefore we chose open surgical repair for our patient (case 7), who had already been treated and presented with relapsed cleft.…”

Section: Discussionmentioning

confidence: 99%

Gaslini's tracheal team: preliminary experience after one year of paediatric airway reconstructive surgery

et al. 2011

Self Cite

View full text Add to dashboard Cite

Backgroundcongenital and acquired airway anomalies represent a relatively common albeit challenging problem in a national tertiary care hospital. In the past, most of these patients were sent to foreign Centres because of the lack of local experience in reconstructive surgery of the paediatric airway. In 2009, a dedicated team was established at our Institute. Gaslini's Tracheal Team includes different professionals, namely anaesthetists, intensive care specialists, neonatologists, pulmonologists, radiologists, and ENT, paediatric, and cardiovascular surgeons. The aim of this project was to provide these multidisciplinary patients, at any time, with intensive care, radiological investigations, diagnostic and operative endoscopy, reconstructive surgery, ECMO or cardiopulmonary bypass. Aim of this study is to present the results of the first year of airway reconstructive surgery activity of the Tracheal Team.Methodsbetween September 2009 and December 2010, 97 patients were evaluated or treated by our Gaslini Tracheal Team. Most of them were evaluated by both rigid and flexible endoscopy. In this study we included 8 patients who underwent reconstructive surgery of the airways. Four of them were referred to our centre or previously treated surgically or endoscopically without success in other Centres.ResultsEight patients required 9 surgical procedures on the airway: 4 cricotracheal resections, 2 laryngotracheoplasties, 1 tracheal resection, 1 repair of laryngeal cleft and 1 foreign body removal with cardiopulmonary bypass through anterior tracheal opening. Moreover, in 1 case secondary aortopexy was performed. All patients achieved finally good results, but two of them required two surgeries and most required endoscopic manoeuvres after surgery. The most complex cases were the ones who had already been previously treated.ConclusionsThe treatment of paediatric airway anomalies requires a dedicated multidisciplinary approach and a single tertiary care Centre providing rapid access to endoscopic and surgical manoeuvres on upper and lower airways and the possibility to start immediately cardiopulmonary bypass or ECMO.The preliminary experience of the Tracheal Team shows that good results can be obtained with this multidisciplinary approach in the treatment of complicated cases. The centralization of all the cases in one or few national Centres should be considered.

show abstract

Endoscopic Laryngotracheal Cleft Repair Without Tracheotomy or Intubation

Cited by 67 publications

References 17 publications

Laryngo-tracheo-oesophageal clefts

Laryngo-tracheo-oesophageal clefts

Surgical management of type III and IV laryngotracheoesophageal clefts: The three-layered approach

Gaslini's tracheal team: preliminary experience after one year of paediatric airway reconstructive surgery

Contact Info

Product

Resources

About