Operative strategy for recurrent laryngeal cleft: A case report and review of the literature

Robie, Daniel K.; Pearl, Richard H.; Gonsales, C.; Restuccia, Rita; Hoffman, Mark A.

doi:10.1016/0022-3468(91)90845-k

Cited by 25 publications

(14 citation statements)

References 21 publications

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“…Even after an uneventful procedure, and irrespective of the technique used, the risk of relapse of the LC (secondary re-opening of the cleft) requiring a revision is high: currently documented at 11% to 50% [29,43,46,58-61]. Thus, multiple procedures are common in LC management.…”

Section: Reviewmentioning

confidence: 99%

Laryngo-tracheo-oesophageal clefts

Leboulanger

Garabédian

2011

Orphanet Journal of Rare Diseases

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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 ...

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Section: Reviewmentioning

confidence: 99%

Laryngo-tracheo-oesophageal clefts

Leboulanger

Garabédian

2011

Orphanet Journal of Rare Diseases

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“…A feed¬ ing gastrostomy obviates this potential complication. These elements of preoperative preparation have been em¬ phasised by Robie et al 18 The surgical approach may be dictated by the health of the patient and by associated congenital abnormalities.…”

Section: Mortalitymentioning

confidence: 99%

Management of Posterior Laryngeal and Laryngotracheoesophageal Clefts

Evans¹,

Courteney-Harris²,

Bailey³

et al. 1995

Archives of Otolaryngology - Head and Neck Surgery

113

126

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“…Endoscopic repair of minor defects such as type 1 or 2 clefts have been described using suspension microlaryngoscopy and laryngeal instruments. 2,3 LTEC can be exposed from a posterior, lateral, or anterior route, 4,5 and an open anterior approach offers good visualization for long clefts such as type 3 or 4 and helps avoid injury to the vagus and recurrent nerves. 4,6-8 However, patients may need mechanical ventilation and stenting for 2 to 3 weeks under deep sedation because of laryngotracheal instability.…”

Section: Discussionmentioning

confidence: 99%

“…4,6-8 However, patients may need mechanical ventilation and stenting for 2 to 3 weeks under deep sedation because of laryngotracheal instability. Cleft repair procedures may be considered under 2 general classifications: recanalization of the esophagus and the trachea after separation 4,5,7,9 and closure of the cleft by creating a partition. 8,10 The first important point is not only making 2 tracts but also creating an adequate lumen for the trachea.…”

Section: Discussionmentioning

confidence: 99%