Endoscopic Surgical Treatment of Laryngotracheal Clefts

Garabédian, Éréa-Noël; Pezzettigotta, S.; Leboulanger, Nicolas; Harris, Robert L.; Nevoux, J.; Denoyelle, Françoise; Roger, Gilles

doi:10.1001/archoto.2009.197

Cited by 32 publications

(40 citation statements)

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“…The length of the cleft repair may have played a part in the dehiscence as there is some evidence to suggest that the longer the cleft, the higher the rate of breakdown [10,11,[13][14][15]. Other factors that may have contributed to the repair dehiscence in this case include a prolonged period of ventilation due to an RSV infection, MRSA colonization and repair of aortic coarctation.…”

Section: Discussionmentioning

confidence: 81%

“…There has been a trend towards endoscopic surgery over open surgery as the preferred technique, even in more extensive clefts [7,8,10]. Our preferred technique is now an endoscopic repair with CO 2 laser (Acublade CO 2 Laser Superpulse at 3 W) to deepithelialize the cleft with closure in two layers.…”

Section: Discussionmentioning

confidence: 99%

“…This is reflected in our study. Debate still remains as to which technique is optimal, in particular for the longer clefts [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

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The management of laryngeal clefts

Thiel

Clement

Kubba

2011

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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The management of laryngeal clefts

Thiel

Clement

Kubba

2011

International Journal of Pediatric Otorhinolaryngology

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“…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

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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.

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“…Children can present with symptoms of stridor, aspiration, and/or respiratory distress (Rahbar 2006). While all type IV clefts require open surgical repair, correction can be done endoscopically in type I-II clefts, and even some type III clefts (Garabedian 2010). Note the "omega" or "tubular" shaped epiglottis.…”

Section: Supraglottis and Glottismentioning

confidence: 99%