Laryngotracheoesophageal cleft: the anterior approach.
Laryngotracheoesophageal cleft was reported by Richter in 1792 after he examined an infant at autopsy and found a common lumen of esophagus and laryngotrachea. The next case was not noted until 1949 by Finlay. A recent review shows 40 cases in the world literature to date. Successful surgical approaches to some of these problems have basically employed a lateral pharyngotomy technique. In the case presented herein, the exact pathology was obscured by a severe tetralogy of Fallot and recurrent pneumonitis from a suspected high H-type tracheoesophageal fistula. The length of this cleft prompted an anterior approach with laryngo-fissure, cricoidotomy, and division of four tracheal rings for a complete and successful repair. Thorough endoscopy of all infants suspected of any laryngeal anomaly would yield an earlier diagnosis and opportunity for reconstruction of the cleft.
D003951:Diagnostic Errors; D005260:Female; D005402:Fistula / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007818:Laryngeal Diseases / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery; D008722:Methods; D011015:Pneumonia, Aspiration / Q000209:etiology; D014138:Tracheoesophageal Fistula / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery