Prevalence of Laryngeal Cleft in Pediatric Patients With Esophageal Atresia

Londahl, Monica; Irace, Alexandria L.; Kawai, Kosuke; Dombrowski, Natasha D.; Jennings, Russell W.; Rahbar, Reza

doi:10.1001/jamaoto.2017.2682

Cited by 26 publications

(26 citation statements)

References 22 publications

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“…The strongest association appears to exist between TBM and EA/TEF and tracheal diverticulum . Synchronous laryngomalacia, laryngeal cleft, vocal‐fold immobility, and subglottic stenosis have also been reported …”

Section: Discussionmentioning

confidence: 94%

“…The trachea and bronchi can be extrinsically compressed by structures such as normal or aberrant vasculature, thyroid goiters, congenital tumors and cysts, and the spine or sternum . TBM is commonly associated with other syndromes or synchronous airway lesions, such as VACTERL, esophageal atresia (EA)/TEF, and laryngeal and laryngotracheal cleft …”

Section: Introductionmentioning

confidence: 99%

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Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy

et al. 2019

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Objectives/Hypothesis Combined anterior and posterior tracheobronchopexy is a novel surgical approach for the management of severe tracheobronchomalacia (TBM). We present our institutional experience with this procedure. Our objective was to determine the utility and safety of anterior and posterior tracheopexy in the treatment of severe TBM. Study Design Retrospective chart review. Methods All patients who underwent anterior and posterior tracheopexy from January 2013 to July 2017 were retrospectively reviewed. Charts were reviewed for indications, preoperative work‐up, tracheobronchomalacia classification and severity, procedure, associated syndromes, synchronous upper aerodigestive tract lesions, and aberrant thoracic vessels. Main outcomes measured included improvement in respiratory symptoms, successful extubation and/or decannulation, vocal fold immobility, and new tracheotomy placement. Results Twenty‐five patients underwent anterior and posterior tracheopexy at a mean age of 15.8 months (range, 2–209 months; mean, 31 months if 2 outliers of 206 and 209 months included). Mean length of follow‐up was 26.8 months (range, 13–52 months). Indications for surgery included apneic events, ventilator dependence, need for positive pressure ventilation, tracheotomy dependence secondary to TBM, recurrent pneumonia, and exercise intolerance. Many patients had other underlying syndromes and synchronous upper aerodigestive tract lesions (8 VACTERL, 2 CHARGE, 1 trisomy 21, 1 Feingold syndrome, 17 esophageal atresia/tracheoesophageal fistula, 20 cardiac/great vessel anomalies, 1 subglottic stenosis, 1 laryngomalacia, 7 laryngeal cleft). At preoperative bronchoscopy, 21 of 25 patients had >90% collapse of at least one segment of their trachea, and the remaining four had 70% to 90% collapse. Following anterior and posterior tracheopexy, one patient developed new bilateral vocal‐fold immobility; one patient with a preoperative left cord paralysis had a new right vocal‐fold immobility. Postoperatively, most patients had significant improvement in their respiratory symptoms (21 of 25, 84%) at most recent follow‐up. Three patients with preexisting tracheotomy were decannulated; two patients still had a tracheotomy at last follow‐up. Two patients required new tracheotomy for bilateral vocal‐fold immobility. Conclusions Combined anterior and posterior tracheopexy is a promising new technique for the surgical management of severe TBM. Further experience and longer follow‐up are needed to validate this contemporary approach and to minimize the risk of recurrent laryngeal nerve injury. Level of Evidence 4 Laryngoscope, 130:E65–E74, 2020

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy

et al. 2019

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“…Of particular note is the relatively high prevalence of LC in patients with oesophageal atresia (EA) with or without TEF. One of the largest and more recently published series to date identified the presence of LC in almost 20% of EA/TEF patients, with more than half of these being LC1 . This behoves the clinician to carefully rule out the presence of an oesophageal anomaly or TEF in patients with suspected LC1, since many TEF subtypes can in fact present subtly.…”

Section: Presentationmentioning

confidence: 97%

Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review

Isaac

El‐Hakim

2018

Clinical Otolaryngology

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Laryngeal cleft (LC) is a congenital anomaly of the aerodigestive tract that has gained increased attention in the recent literature. The evaluation, diagnosis and management of the mildest and most controversial form of the disease, termed type 1 laryngeal cleft (LC1), have been repeatedly cited in the context of feeding and swallowing disorders in children (FSD), mostly in North American literature. 1-7 The purpose of this article is to review the current state of the literature on LC1 in the context of managing the child with FSD and provide a summary of current diagnostic and management strategies, as well as ongoing challenges. | EMBRYOLOGYDuring embryological development, the trachea and oesophagus initially share a common lumen, and are later separated by a septum, which is normally fully formed by 35 days gestation. 8 The occurrence of LC is caused by a failure of the posterior cricoid and laryngeal tissues to fuse during development, resulting in a communication between the larynx/trachea and the hypopharynx/ oesophagus. This arrest of fusion can occur at any point between the 5th and 7th weeks of gestation, resulting in varying degrees of clefting. 9,10 The end result is a partial communication between the airway and digestive tract that can cause feeding and swallowing disorders (FSD) and/or airway distress of varying severity.

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“…The laryngotracheobronchoscopy performed prior to definitive surgery using rigid or flexible bronchoscope has been recommended for every neonate with this anomaly (6). Aside from the location and size of the fistula, it has been reported that the associated secondary upper airway anomalies such as laryngeal cleft, laryngomalacia, subglottic stenosis, tracheomalacia and vocal fold paresis, which worth evaluation due to their incidence and their impact on ventilation, as well as, airway management itself (7)(8)(9).…”

Section: Anesthetic ıNduction and Airway Managementmentioning

confidence: 99%

Anesthetic management of tracheo-esophageal fistula

Üzümcügil¹

2022

Curr Chall Thorac Surg

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The anesthetic management of a neonate diagnosed to have tracheoesophageal fistula with or without esophageal atresia (EA) is challenging, especially due to abnormally connected airway and esophagus interfering with patency of the airway and compromising ventilation. The anatomical variations regarding this congenital anomaly and the associated anomalies in various systems, determines both the surgical intervention and the anesthetic management. An urgent surgical intervention may be required within the first 48 hours after birth in case of severe respiratory compromise. On the other hand, a staged approach may be preferred including a gastrostomy in case of either the presence of low-birth-weight, isolated EA or more critical co-morbidities. A laryngotracheobronchoscopy is often performed prior to definitive surgery in order to identify the location and size of fistula, as well as, secondary upper airway anomalies. In the preoperative period, airway must be secured, and optimizing the status of the neonate in terms of other system functions should have a high priority. Intraoperatively, regardless of the agents used, the anesthetic management should focus on adequate depth of anesthesia, and adequate ventilation and oxygenation. The coordination between the anesthetist and the surgeon is crucial during the surgery in order to secure adequate ventilation and oxygenation. The associated anomalies should be considered as the main determinants of perioperative mortality and morbidity, hence, anesthetic management should also focus on intraoperative maintenance of preoperatively optimized functions. The analgesic management in the postoperative period is often provided by multimodal analgesic use.

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Prevalence of Laryngeal Cleft in Pediatric Patients With Esophageal Atresia

Abstract: Pediatric patients with EA/TEF have a much greater prevalence of laryngeal cleft than the general population. Multidisciplinary esophageal and airway programs serve as an ideal clinical setting for management of EA/TEF.

Cited by 26 publications

References 22 publications

Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy

Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy

Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review

Anesthetic management of tracheo-esophageal fistula

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