title: Surgical management for posterior laryngeal cleft developing subglottic airway obstruction.
abstract: A 3-year-old boy associated with Opitz syndrome including hypospadias and anorectal anomaly was transferred to Osaka University Hospital with orotracheal intubation because of respiratory distress after respiratory infection. He had laryngeal cleft diagnosed in the neonatal period because of symptoms including stridor and aspiration. After 2 attempts at extubation, tracheostomy was performed. Fiberscopic examination demonstrated obstruction of the airway from the vocal cord to subglottic space by inspired esophageal redundant mucosa. There was no improvement observed for 3 months. He underwent anterior repair of cleft, anterior laryngotracheoplasty with costal cartilage graft, closure of tracheostomy, and endoscopic Nissen fundoplication. The postoperative course during the subsequent year was uneventful without feeding or speaking disorders. Subglottic airway obstruction caused by inspired redundant mucosa is a rare complication in laryngeal cleft. Anterior laryngotracheoplasty and Nissen fundoplication should be considered for this complication, in addition to the usual procedure for cleft repair.
authors.affiliation: Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan. kamata@pedsurg.med.osaka-u.ac.jp
authors.forename: Shinkichi
authors.initials: S
authors.lastname: Kamata
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.forename: Noriaki
authors.initials: N
authors.lastname: Usui
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kamiyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Soh
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fukuzawa
mesh_terms: D000015:Abnormalities, Multiple / Q000235:genetics / Q000601:surgery*; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery; D002356:Cartilage / Q000637:transplantation; D002675:Child, Preschool; D004947:Esophagus / Q000473:pathology; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D006801:Humans; D006972:Hypertelorism / Q000235:genetics; D007021:Hypospadias / Q000235:genetics; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery*; D008297:Male; D009092:Mucous Membrane / Q000473:pathology; D011015:Pneumonia, Aspiration / Q000209:etiology; D012135:Respiratory Sounds / Q000209:etiology; D013577:Syndrome; D014139:Tracheostomy