title: Unexpected presentation of a type IV laryngo-tracheo-oesophageal cleft: Anaesthetic implications of a rare case.
abstract: Laryngo-tracheo-oesophageal cleft (LTEC) is a congenital midline defect of the posterior larynx and trachea and the anterior wall of the oesophagus. Existence of these clefts may not be apparent during pre-operative evaluation. We present a rare case of a neonate initially scheduled for tracheo-oesophageal fistula repair. Unexplained air leak in spite of placement of size 4.0 mm endotracheal tube in a 2.5 kg neonate triggered extensive intra-operative evaluation of the airway anatomy via flexible and rigid bronchoscope. A type IV LTEC with an unusual anatomy was identified that was considered surgically irreparable. This case also highlights the need for a team approach and preparedness of anaesthesiologists for a difficult airway while managing such cases. Maintenance of high degree suspicion is warranted.
authors.affiliation: Department of Anesthesiology and Peri-Operative Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dwarakanath
authors.affiliation: Department of Anesthesiology, University of Kentucky, Lexington, KY, USA.
authors.forename: Arundathi
authors.initials: A
authors.lastname: Reddy
keywords: Airway management; congenital laryngo-tracheo-oesophageal cleft; difficult paediatric airway