We report anesthetic management of a patient with laryngotracheoesophageal cleft which lacks partition between the esophagus and upper airway, a rare congenital anomaly with a high mortality. A male baby weighting 2.96 kg was born at 39-week gestation. He had respiratory distress, hoarse cry and cyanosis on feeding. Gastric cardioplasty was scheduled at the age of 10 days, under the presumptive diagnosis of gastroesophageal regurgitation. Endotracheal intubation was performed and anesthesia with 1-3% sevoflurane and 100% oxygen was started. However, SpO2 dropped suddenly and transiently. Endoscopic examination performed transnasally and through the endotracheal tube demonstrated that the septum between the trachea and esophagus was absent from the larynx through the entire length of the trachea. On the basis of these finding, this case was diagnosed as laryngotracheoesophageal cleft (type 3). Esophageal division and gastrostomy were performed to prevent regurgitation and aspiration of gastric content.
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Article Synopsis
- Laryngotracheoesophageal cleft (LTEC) is a rare congenital condition where the larynx and trachea are abnormally connected behind the esophagus, often linked with other gastrointestinal issues.
- A case was reported where a male fetus had a gastric polypoid lesion detected via ultrasound, leading to frequent vomiting and respiratory problems after birth.
- After examinations revealed LTEC type III, a partial gastrectomy showed that the tumor had characteristics similar to bronchial tissue, suggesting the gastric tissue abnormalities may stem from the same developmental issues causing LTEC.
Our aim of this study is to describe the outcomes of a series of patients who underwent cleft repair and posterior cartilage grafts laryngotracheoplasty (LTP) from anterior midline cervical approach for type Ⅲ laryngotracheoesophageal clefts (LETC). A review of patients with type Ⅲ LETC between May 2017 and December 2021 was performed. Demographic features including gender, age at surgery, weight, airway support, feeding status, and airway and other comorbidities were collected preoperatively.
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