New cervical approach for tracheopexy

Abstract

Deficiency of the tracheal cartilage is known to occur with oesophageal atresia resulting in abnormal compressibility. It does not require treatment unless symptomatic. Symptoms comprise apnoeic or cyanotic spells, often precipitated by feeds, and recurrent chest infections. When other causes such as stricture, recurrent fistula and gastro-oesophageal reflux have been excluded, the abnormality can be diagnosed radiologically and endoscopically. Previously tracheopexy through a lateral thoracic approach has been described. We describe three patients who had a successful tracheopexy through an anterior cervical approach, which is simpler, and a fourth in whom there was partial alleviation.

Tracheomalacia in esophageal atresia. Usefulness of preoperative imaging evaluation for tailored surgical correction

“…We think that the use of a low cervical incision with a split of the sternal manubrium [13,14] permits a surgically btailoredQ approach based on the endoscopic and radiology findings.…”

Tracheomalacia and Tracheobronchomalacia in Children and Adults

“…However, it is an invasive procedure that may not adequately treat distal bronchial lesions and may not be tolerated well by patients with complicated conditions. 87 Treatment with tracheopexy, 35,147,148 tracheal resection, 31,149 and tracheal reconstruction 150 have been attempted with limited success.…”

Tracheomalacia in oesophageal atresia: morphological considerations by endoscopic and CT study☆

“…Our analysis of the results, therefore, permits us to draw some conclusions: (a) OA exhibits a high number of morphological variations of the mediastinal structure, some of which are not clinically influential; (b) the use of routine airway assessment by endoscopic procedure is mandatory in all cases of OA before the fourth month of life, and in TM positive cases CT examination was carried out using axial helical computed tomography with a contrast medium; (c) correction of the TM cannot be always effected using a standard operation that does not include consideration of any multiform structural anomalies of the mediastinum, and for this reason we always recommend a surgically 'tailored' approach based on the endoscopic and radiology findings; (d) corrective surgery must be performed using one 'window of access' to the airway, differently from Gross' traditional approach, and we think that the use of a low cervical incision with a split of the sternal manubrium, as recommended by some surgeons [20,21], meets this need better; (e) the importance of the use of intraoperative broncoscopy in the correction of a TM.…”