title: Repair of short type IV laryngotracheoesophageal cleft using long, tapered, engaging graft without need for tracheotomy.
abstract: An infant with a type IV laryngotracheoesophageal cleft underwent transcervical repair using a long tapered cartilage graft. A laryngofissure was carried down to the innominate artery to expose the cleft that extended 5 mm inferior to the vessel. The edges of the cleft were excised, the trachealis was separated from the esophagus that was reapproximated, and clavicular periosteum was placed. A long posterior costal cartilage graft that tapered inferiorly in anteroposterior dimension and engaged behind the cricoid plate was inserted. This added rigidity to the repair and obviated the need for a tracheotomy while providing a four-layer closure.
  
  
  METHODS
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authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.|Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Propst
mesh_terms: D000013:Congenital Abnormalities / Q000601:surgery*; D004947:Esophagus / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007828:Laryngoscopy; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery; D008297:Male; D012272:Ribs / Q000637:transplantation*; D014132:Trachea / Q000002:abnormalities* / Q000601:surgery*
keywords: Laryngeal cleft; aspiration; cervical approach; clavicle; clavicular; laryngotracheoesophageal cleft; long; long tapered engaging graft; periosteum; type 4; type IV