Surgical Treatment of Congenital Laryngotracheo-oesophageal Cleft

Strategies for managing Type IV laryngotracheoesophageal clefts at Great Ormond Street Hospital for Children

“…However we have found it to be an excellent approach for long Types II-IV LTOCs. Laryngeal stability and development are not adversely affected by the anterior laryngofissure approach and this has also been the view of others [11,30,31].…”

“…It is preferable to manage the airway with a nasotracheal or orotracheal tube during the postoperative period with the child kept paralysed [11,31], although many children ultimately need a tracheostomy when the repair is soundly healed because of tracheomalacia preventing extubation. Four of the six (66.7%) Group B cases required tracheostomy at ages ranging from 44 to 87 days.…”

Congenital laryngotracheo‐oesophageal cleft: successful ventilation with the Laryngeal Mask AirwayTM

“…More than one‐half of patients have associated congenital abnormalities, including gastrointestinal, cardiac and genitourinary malformations and chromosomal aberrations (7). Early repair in a specialized centre, usually by an anterior translaryngeal approach (7,8), is the recommended treatment of choice.…”

Stridor in the neonate and infant. Implications for the paediatric anaesthetist. Prospective description of 155 patients with congenital and acquired stridor in early infancy

“…Severe stridor and gurgling accompanied the short periods of spontaneous breathing in this infant and were assumed to be due to lung disease, thus preventing a search for an alternative diagnosis. A simple instrument, designed by Berkovits ( 12) was used to establish the diagnosis and measure the exact length of the cleft which is often underestimated. Treatment of laryngotracheal clefts proved to be highly unsatisfactory.…”

“…Endoscopy clearly showed bilateral compression of the suture line of the cleft by the tracheal and nasogastric tubes, leading to dehiscence of the wound. Success of surgical treatment obviously depends on two prerequisites, namely a tracheostomy and placement of a gastrostomy tube ( 12). Only when these conditions had been applied, could the surgeons treat one cleft by one operation.…”