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Nebor I, Katz Kadosh O, Tabangin ME, Hart CK, Myer CM, Smith MM, Meinzen-Derr JK, Rutter M, de Alarcón A. Does the History of Tracheoesophageal Fistula Repair Alter Outcomes of Laryngeal Cleft Repair? Otolaryngol Head Neck Surg 2023; 168:39-44. [PMID: 35536656 DOI: 10.1177/01945998221094210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Tracheoesophageal fistula and esophageal atresia (TEA) and laryngeal cleft (LC) can coexist in some patients. The surgery-specific success rate of LC repair in children with associated TEA has not been well described. The aim of the study is to determine if the history of TEA alters the LC repair outcomes. STUDY DESIGN Case series with chart review. SETTING Single-institution academic medical center. METHOD A retrospective review was conducted of patients with LC with and without TEA repair between January 2001 and November 2020. Data collected and analyzed included demographics and clinical characteristics, LC type, and LC with TEA timing of repairs. RESULTS An overall 282 patients met the inclusion criteria of LC repair: LC (n = 242, 85.8%) and LC + TEA (n = 40, 14.2%). Revision repair was required in 43 patients (15.2%) with 8 (2.8%) needing a second revision repair. The first LC revision rate in the LC group was 36/242 (14.9%) as compared with 7/40 (17.5%) in the LC + TEA group (P = .67). The second LC revision rate in the LC and LC + TEA groups was 7 (2.9%) and 1 (2.4%), respectively. The median time to revision was 5.1 months (interquartile range, 3.45-10.6) in the LC group as compared with 29.2 months (interquartile range, 4.8-44.2) in the LC + TEA group (P = .06). CONCLUSION The incidence of TEA and LC was 14.2% in our study. Based on our findings, history of TEA repair is not associated with a higher revision rate vs LC alone. The history of TEA repair did not alter the outcomes of LC repair.
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Affiliation(s)
- Ivanna Nebor
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Orna Katz Kadosh
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles M Myer
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Matthew M Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jareen K Meinzen-Derr
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alessandro de Alarcón
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Wendt KD, Brown J, Lungova V, Mohad V, Kendziorski C, Thibeault SL. Transcriptome Dynamics in the Developing Larynx, Trachea, and Esophagus. Front Cell Dev Biol 2022; 10:942622. [PMID: 35938172 PMCID: PMC9353518 DOI: 10.3389/fcell.2022.942622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
The larynx, trachea, and esophagus share origin and proximity during embryonic development. Clinical and experimental evidence support the existence of neurophysiological, structural, and functional interdependencies before birth. This investigation provides the first comprehensive transcriptional profile of all three organs during embryonic organogenesis, where differential gene expression gradually assembles the identity and complexity of these proximal organs from a shared origin in the anterior foregut. By applying bulk RNA sequencing and gene network analysis of differentially expressed genes (DEGs) within and across developing embryonic mouse larynx, esophagus, and trachea, we identified co-expressed modules of genes enriched for key biological processes. Organ-specific temporal patterns of gene activity corresponding to gene modules within and across shared tissues during embryonic development (E10.5-E18.5) are described, and the laryngeal transcriptome during vocal fold development and maturation from birth to adulthood is characterized in the context of laryngeal organogenesis. The findings of this study provide new insights into interrelated gene sets governing the organogenesis of this tripartite organ system within the aerodigestive tract. They are relevant to multiple families of disorders defined by cardiocraniofacial syndromes.
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Affiliation(s)
- Kristy D. Wendt
- Department of Surgery, Division of Otolaryngology, Head, and Neck Surgery, University of Wisconsin, Madison, WI, United States
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Jared Brown
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, United States
| | - Vlasta Lungova
- Department of Surgery, Division of Otolaryngology, Head, and Neck Surgery, University of Wisconsin, Madison, WI, United States
| | - Vidisha Mohad
- Department of Surgery, Division of Otolaryngology, Head, and Neck Surgery, University of Wisconsin, Madison, WI, United States
| | - Christina Kendziorski
- Department of Biostatistics and Medical Information, University of Wisconsin-Madison, Madison, WI, United States
| | - Susan L. Thibeault
- Department of Surgery, Division of Otolaryngology, Head, and Neck Surgery, University of Wisconsin, Madison, WI, United States
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Susan L. Thibeault,
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Pandey G, Rudd J, Konstantinidou S, Butler C. Simultaneous anterior cervical repair of type IV laryngeal cleft and tracheo-oesophageal fistula. BMJ Case Rep 2022; 15:e243515. [PMID: 35039336 PMCID: PMC8768001 DOI: 10.1136/bcr-2021-243515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gargi Pandey
- ENT, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - James Rudd
- ENT, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Colin Butler
- ENT, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Quick ME, Giblett N, Uwiera TC, Herbert H, Vijayasekaran S. A novel approach in managing challenging tracheoesophageal fistulae. Int J Pediatr Otorhinolaryngol 2020; 138:110261. [PMID: 32798829 DOI: 10.1016/j.ijporl.2020.110261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the outcomes of an open anterior cervical approach and tospecifically describe a novel extended tracheotomy incision ("Key-hole technique") torepair H-type and other challenging tracheoesophageal fistulae (TOF) at a singletertiary pediatric center. METHOD A retrospective chart analysis of pediatric patients (0-18 years old) who had undergone repair of TOF's between January 2006 and March 2020 were reviewed. A case series of patients who had undergone open cervical utilizing three different techniques were included. Patient demographics, surgical management and post-operative surgical outcomes including complications were evaluated. RESULTS During the study period, 117 pediatric patients were diagnosed and anaged with TOFs with or without oesophageal atresia. Within this group, 12 patients (10%) had anterior open cervical repair of congenital or persisting TOFs (6 males and 6 females). Eight cases (7%) had congenital Type E (known as H-type), two had type D, one type B and one type C TOF. Median gestational age was 37 weeks (range 28-41 weeks), age of presentation ranged from 1 day old to 3 years old with 67% being diagnosed within the first month of life. At the time of definitive surgery all patients had a bronchoscopy and oesophagoscopy to confirm the diagnosis, identify the level of the fistula and place a catheter through the fistula. This cases series of open anterior cervical repair of TOFs comprised of seven (58%) patients who had primary extraluminal tracheal approach, four (33%) with extended tracheotomy incision ('Key-hole' technique) and one (9%) patient with slide tracheoplasty for recurrent type C TOF in the presence of subglottic stenosis. Eleven of the twelve patients had successful open anterior cervical repair of TOF. One patient who had primary open anterior cervical repair with the 'Key-hole' technique had recurrence managed successfully with slide tracheoplasty. There were no cases of recurrent laryngeal nerve injury. CONCLUSION This series demonstrates that open anterior cervical approach to correct TOFs is an effective and safe method in the majority of cases of congenital and acquired fistulae where there is no oesophageal atresia or the atresia is corrected (in the case of recurrent or second fistulae). We also present the outcomes of a novel surgical "Keyhole" technique to manage TOF fistulas via an extended-tracheotomy incision. We also found that slide tracheoplasty is an effective salvage operation in the case of complex recurrent fistulae.
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Affiliation(s)
- Mark E Quick
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, WA, Australia.
| | - Neil Giblett
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Trina C Uwiera
- Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hayley Herbert
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, WA, Australia; Faculty of Health and Medical Sciences, University of Western Australia, WA, Australia
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Criticality in tailoring the treatment for tracheoesophageal fistulas in children. Eur Arch Otorhinolaryngol 2019; 277:631-639. [PMID: 31707468 DOI: 10.1007/s00405-019-05720-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Tracheo-oesophageal fistula (TOF) is a rare pathology. It can be congenital and concurrent with other congenital anomalies such as oesophageal atresia, laryngeal and tracheal agenesis, or it can be acquired. The purpose of this study was to analyse various management strategies and their outcomes in infants and children with TOF and identify potential areas for standardisation of the fistula repair procedures. METHODS At a single institution, a retrospective analysis of infants and children with congenital or acquired TOF between 2013 and 2019 was performed. Thirteen patients were identified. Data collection included: patient demography, associated congenital anomalies, details of fistula at the time of endoscopy, surgical approach and intra-operative findings, need for additional intervention(s), and outcomes. RESULTS Thirteen patients underwent endoscopic or open surgeries for correction of TOF. The TOF was congenital in ten patients and acquired in three patients. Eight patients had associated aero-digestive comorbidities, and six patients had systemic comorbidities. Three patients underwent endoscopic procedures and nine patients underwent an open TOF repair. One patient had tracheal agenesis and was not offered any treatment. Two patients required multiple endoscopic interventions for recurrent TOFs. Among four patients with prior tracheostomy, three were decannulated and one awaits decannulation. Conclusıon Appropriate case selection and surgical ergonomics are essential for patients with TOF to avoid recurrences. Preoperative endoscopy to obtain precise details regarding associated laryngotracheal lesions and demographics of the fistula is crucial.
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Londahl M, Irace AL, Kawai K, Dombrowski ND, Jennings R, Rahbar R. Prevalence of Laryngeal Cleft in Pediatric Patients With Esophageal Atresia. JAMA Otolaryngol Head Neck Surg 2019; 144:164-168. [PMID: 29270628 DOI: 10.1001/jamaoto.2017.2682] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), and laryngeal cleft are rare congenital anomalies that often occur together. Previous reports have established a link between EA/TEF and laryngeal cleft, but there have been no large case series to further characterize this relationship. Objectives To assess the prevalence of laryngeal cleft among patients with EA/TEF, identify associations between types of laryngeal cleft and EA/TEF, and identify factors associated with the timing of diagnosis for both conditions. Design, Setting, and Participants Retrospective analysis of 270 patients. The Esophageal Atresia database was used to identify patients seen at the Esophageal and Airway Treatment (EAT) Center at Boston Children's Hospital, Boston, Massachusetts, a tertiary referral hospital, from August 1, 2009, to August 1, 2016. Patients were included if they were younger than 18 years at the time they were diagnosed with EA, TEF, or both and had undergone a procedure or examination by a surgeon from the EAT Center. Patients with acquired airway or esophageal problems were excluded. Main Outcomes and Measures Data regarding patient demographics, primary diagnoses, dates of diagnosis, comorbidities, and airway/esophageal surgical interventions were collected and analyzed. Association between type of EA/TEF and laryngeal cleft type was evaluated. Secondary outcomes were age at diagnosis between patients who resided in Massachusetts and those who resided outside the state. Results Of 270 patients diagnosed with EA/TEF during the 7-year period, 138 (51.1%) were male, and the median age at diagnosis of EA/TEF was 1.0 years (IQR, 0.4-2.0) and at diagnosis of laryngeal cleft was 1.1 years (interquartile range [IQR], 0.6-2.8). Laryngeal cleft was diagnosed in 53 of the 270 patients (19.6%) (95% CI, 14.9%-24.4%). No apparent difference was found in the distribution of types of laryngeal cleft by type of EA/TEF. Among patients with EA/TEF type A or B, 9 patients (56%) had a type I cleft, 6 (38%) had a type II cleft, and 1 (6%) had a type III cleft. Among those with EA/TEF type C or D, 20 (57%) had a type I cleft, 11 (31%) had a type II cleft, and 3 (9%) had a type III cleft. Out-of-state patients were more likely to be diagnosed with EA/TEF at an older age than in-state patients (mean difference, 1.5 years; 95% CI, 0-2.9 years). Conclusions and Relevance Pediatric patients with EA/TEF have a much greater prevalence of laryngeal cleft than the general population. Multidisciplinary esophageal and airway programs serve as an ideal clinical setting for management of EA/TEF.
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Affiliation(s)
- Monica Londahl
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandria L Irace
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Natasha D Dombrowski
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Russell Jennings
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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Sadreameli SC, McGrath-Morrow SA. Respiratory Care of Infants and Children with Congenital Tracheo-Oesophageal Fistula and Oesophageal Atresia. Paediatr Respir Rev 2016; 17:16-23. [PMID: 25800226 PMCID: PMC4559488 DOI: 10.1016/j.prrv.2015.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 02/07/2023]
Abstract
Despite acute respiratory and chronic respiratory and gastro-intestinal complications, most infants and children with a history of oesophageal atresia / trachea-oesophageal fistula [OA/TOF] can expect to live a fairly normal life. Close multidisciplinary medical and surgical follow-up can identify important co-morbidities whose treatment can improve symptoms and optimize pulmonary and nutritional outcomes. This article will discuss the aetiology, classification, diagnosis and treatment of congenital TOF, with an emphasis on post-surgical respiratory management, recognition of early and late onset complications, and long-term clinical outcomes.
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8
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Yalamachili S, Virk JS, Bajaj Y. Diagnosis and management of laryngeal cleft: A single centre experience and a novel endoscopic technique. World J Otorhinolaryngol 2015; 5:105-109. [DOI: 10.5319/wjo.v5.i4.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/23/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the presentation, diagnosis and outcomes of patients with laryngeal cleft.
METHODS: An 18 mo (from mid-2012 to 2013) prospective longitudinal study was performed at the Barts Children’s and Royal London Hospital, a tertiary referral centre. Chart review was performed for all patients including data extraction of demographics, outpatient clinic review documentation, speech therapy findings, medication list, operative findings alongside technique and follow up. A systematic review of contemporary English medical literature was also reviewed to compare series. The study was approved and registered by the hospital clinical governance and audit board. Biostatistician review was not required.
RESULTS: Twenty-two children aged 1 to 72 mo (mean age 23.5 mo) with a 7:4 male-female ratio. Twenty had Benjamin-Evans type 1 clefts and 2 had a type 2 cleft. All were symptomatic despite medical management including anti-reflux therapy. Patients presented with dyspnoea (81%), feeding difficulty (63%), stridor (54%) and recurrent pneumonia (36%). Several patients had concomitant aerodigestive abnormalities including 7 with laryngomalacia, 4 subglottic stenosis, 2 subglottic webs and 1 tracheo-oesophageal fistula. To date, 18 patients have undergone endoscopic repair, all of whom have shown radiological and/or clinical signs of improvement. All endoscopic repairs were performed with the novel use of a Negus knot pusher, with Baby Benjamin rigid suspension, to more reliably and easily suture at depth.
CONCLUSION: This is a significant single unit series demonstrating the strong association of laryngeal cleft with combined aerodigestive symptoms and other laryngeal abnormalities. Endoscopic management of type 1 and 2 laryngeal clefts is successful. We recommend the use of a Negus knot pusher to facilitate endoscopic repair.
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Hseu A, Recko T, Jennings R, Nuss R. Upper Airway Anomalies in Congenital Tracheoesophageal Fistula and Esophageal Atresia Patients. Ann Otol Rhinol Laryngol 2015; 124:808-13. [DOI: 10.1177/0003489415586844] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To examine the prevalence of upper airway anomalies in patients diagnosed with congenital tracheoesophageal fistula and esophageal atresia (TEF/EA). Methods: A retrospective review was conducted of all TEF/EA patients seen at a tertiary pediatric hospital between January 2008 and December 2013. Inclusion criteria included evaluation by the otolaryngology service. Exclusion criteria included age >18 years, acquired TEF/EA, subsequent rule out of TEF/EA, and otolaryngology evaluation for reasons not pertaining to the airway. Data collected and analyzed included demographics, comorbidities, presenting symptoms, surgical interventions, laryngoscopic and bronchoscopic examinations, and subsequent medical and surgical management. Results: Four hundred and thirty patients were diagnosed with TEF/EA at our institution. In all, 32.3%, or 139 children, were included in the analysis; 56.1% (n = 78) male, 43.9% (n = 61) female. Of the analyzed patients, 4.3% (n = 6) were diagnosed with laryngomalacia. Eighteen patients (12.9%) were diagnosed with subglottic stenosis. Thirty (21.6%) had vocal fold paresis or immobility. Laryngeal cleft was diagnosed in 25.9% (n = 36). Tracheomalacia was the most common airway finding, diagnosed in 37.4% (n = 52) patients. Conclusion: Patients diagnosed with congenital TEF/EA have a high rate of secondary upper airway anomalies. Consideration should be given to perform a complete airway evaluation in all of these patients.
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Affiliation(s)
- Anne Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Thomas Recko
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Russell Jennings
- Department of Pediatric Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Roger Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
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Fraga JC, Adil EA, Kacprowicz A, Skinner ML, Jennings R, Lillehei C, Rahbar R. The association between laryngeal cleft and tracheoesophageal fistula: Myth or reality? Laryngoscope 2014; 125:469-74. [DOI: 10.1002/lary.24804] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 05/03/2014] [Accepted: 06/03/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Jose C. Fraga
- Pediatric Thoracic Surgery Unit/Pediatric Surgery Service; Hospital de Clínicas de Porto Alegre; Department of Surgery; School of Medicine, Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
| | - Eelam A. Adil
- Department of Otology and Laryngology; Harvard Medical School; Boston Children's Hospital; Boston Massachusetts U.S.A
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts U.S.A
| | - Amy Kacprowicz
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts U.S.A
| | - Margaret L. Skinner
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Russell Jennings
- Department of Surgery; Boston Children's Hospital; Boston Massachusetts U.S.A
| | - Craig Lillehei
- Department of Surgery; Boston Children's Hospital; Boston Massachusetts U.S.A
| | - Reza Rahbar
- Department of Otology and Laryngology; Harvard Medical School; Boston Children's Hospital; Boston Massachusetts U.S.A
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts U.S.A
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Mangat HS, El-Hakim H. Injection augmentation of type I laryngeal clefts. Otolaryngol Head Neck Surg 2012; 146:764-8. [PMID: 22261489 DOI: 10.1177/0194599811434004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe a series of children diagnosed with type I congenital laryngeal clefts (LC-I) and treated, due to various presentations, with endoscopic injection augmentation (IA). STUDY DESIGN Case series with chart review. SETTING Tertiary care academic children's hospital in Edmonton, Canada. SUBJECTS All pediatric patients diagnosed with LC-I and treated with IA in a single tertiary care practice. METHODS The children were identified from a prospectively collected database. Only those who were treated with IA and had a minimum follow-up of 3 months were included. The authors collected demographics, diagnoses, surgical procedures, number of IA procedures, clinical outcomes, and complications. RESULTS Over a period of 8 years, 43 patients were diagnosed with LC-I. Eighteen had undergone IA over the past 4 years. Mean age at IA was 37.11 ± 32.68 months with a male-to-female ratio of 1.25:1. The indications were swallowing dysfunction (13), atypical croup (2), chronic cough (1), cyanotic spells (1), and asthma (1). Seven patients required repeated injections (mean, 2.57 injections). A total of 13 patients responded with resolution of symptoms in question. A single postoperative complication was recorded. CONCLUSION IA is a brief, simple management option that succeeds in a number of children with LC-I. It is minimally morbid and supplements other conservative approaches to treat the condition.
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12
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Thiel G, Clement WA, Kubba H. The management of laryngeal clefts. Int J Pediatr Otorhinolaryngol 2011; 75:1525-8. [PMID: 21937125 DOI: 10.1016/j.ijporl.2011.08.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To review the clinical presentation and management of all infants and children presenting with laryngeal clefts to a tertiary pediatric ENT centre and to identify changes in practice over time. PATIENTS AND METHODS A retrospective case note review of the management of all infants and children with a diagnosis of a laryngeal cleft identified in our Department between 01/11/2003 and 31/12/2010. RESULTS Twelve children with laryngeal clefts were identified. Six clefts were grade 1, five grade 2 and one grade 3b. All grade 1 clefts were managed conservatively. Of the grade 2 clefts, four required surgery with one being managed conservatively. Two were repaired using an open technique and two using an endoscopic technique. The grade 3b cleft was repaired endoscopically. Two cleft repairs broke down post-operatively requiring further surgery. CONCLUSIONS Conservative management remains the management of choice for lower grade clefts. Where a laryngeal cleft requires repair there has been a trend towards the endoscopic over open technique, even of more extensive clefts.
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Affiliation(s)
- Gundula Thiel
- Department of Paediatric Otolaryngology - Head and Neck Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom.
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Oestreicher-Kedem Y, DeRowe A, Nagar H, Fishman G, Ben-Ari J. Vocal fold paralysis in infants with tracheoesophageal fistula. Ann Otol Rhinol Laryngol 2009; 117:896-901. [PMID: 19140535 DOI: 10.1177/000348940811701206] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We describe the clinical characteristics and management of vocal fold paralysis in infants who were born with a tracheoesophageal fistula (TEF). METHODS This retrospective case series included all infants born with TEFs who presented to our pediatric otolaryngology unit and intensive care unit because of dyspnea or aphonia in the years 2005 and 2006, and who were found to have vocal fold paralysis. RESULTS Five boys and 1 girl were studied. One infant had stridor before TEF repair, and 5 after it. All children underwent flexible laryngotracheobronchoscopy and were treated in the pediatric intensive care unit before diagnosis of the vocal fold paralysis (5 bilaterally and 1 unilaterally) was made. The ages at diagnosis of paralysis ranged between 14 days and 14 months. Five infants required tracheostomy. CONCLUSIONS Vocal fold paresis in infants is difficult to diagnose. The risk for recurrent laryngeal nerve injury associated with TEF and TEF repair should be emphasized in these children. We recommend that all newborns with TEF should be examined by an otolaryngologist before operation to confirm the mobility of the vocal folds and to rule out other associated airway malformations, and examined after operation if respiratory difficulties develop.
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Affiliation(s)
- Yael Oestreicher-Kedem
- Pediatric Otolaryngology Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Ketcham AS, Smith JE, Lee FS, Halstead LA, White DR. Clinical course following endoscopic repair of type 1 laryngeal clefts. Int J Pediatr Otorhinolaryngol 2008; 72:1261-7. [PMID: 18584883 DOI: 10.1016/j.ijporl.2008.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 05/08/2008] [Accepted: 05/09/2008] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Treatment of type I laryngeal clefts (T1LCs) remains controversial. We present our experience with 16 endoscopic T1LC repairs to evaluate the effect of patient characteristics and surgical technique on outcomes. METHODS A retrospective study was performed. Diagnosis of T1LC was made by interarytenoid palpation during operative microlaryngoscopy. Two surgeons performed endoscopic repair using either microflap reconstruction or laser demucosalization and reapproximation. All patients received preoperative and postoperative modified barium swallow (MBS) studies. Improved MBS at 3-5 months determined success of repair. Factors contributing to success of repair were analyzed statistically. RESULTS No intraoperative complications occurred. One T1LC repair dehisced after 3 months. Overall, 11 of 16 repairs (68.8%) were successful. Mean age at repair was 23.3 months. Length of stay for microflap repair was significantly shorter than for laser reapproximation (0.89 days vs. 4.6 days, p<0.001, two-tail t-test). The difference in patient age between failures and successes (21.3 months vs. 24.2 months) was non-significant (p=0.661, two-tail t-test). Success for the nine patients receiving microflap reconstruction (77.8%) vs. the seven receiving laser reapproximation (57.1%) is comparable (p=0.596, Fisher's exact test). No correlation between comorbidities and failure was found (p>0.05, Fisher's exact test). CONCLUSIONS This series matches the largest reported series of endoscopic T1LC repairs. Success rates were lower than in previously reported studies, and comorbidities were higher. However, comorbidities did not contribute to surgical failure. No difference in outcome was seen between the two endoscopic techniques. Microflap repair may require a shorter hospital stay.
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Affiliation(s)
- Amy S Ketcham
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, United States
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15
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Antao B, Soccorso G, Bateman N, Shawis R. H-type tracheoesophageal fistula with type III laryngotracheoesophageal cleft. Eur Arch Otorhinolaryngol 2007; 264:1373-6. [PMID: 17558506 DOI: 10.1007/s00405-007-0356-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 05/14/2007] [Indexed: 11/29/2022]
Abstract
H-type tracheoesophageal fistula and laryngotracheoesophageal cleft are both rare anomalies. Laryngotracheoesophageal clefts are identified as a part of Opitz-Frias syndrome. We report a neonate with this combination of rare congenital anomalies. These associated malformations can have major implications in terms of resuscitation, diagnosis and surgical management, which are discussed.
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Affiliation(s)
- Brice Antao
- Paediatric Surgical Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.
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16
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Kubba H, Gibson D, Bailey M, Hartley B. Techniques and outcomes of laryngeal cleft repair: an update to the Great Ormond Street Hospital series. Ann Otol Rhinol Laryngol 2005; 114:309-13. [PMID: 15895787 DOI: 10.1177/000348940511400410] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We present an update to the Great Ormond Street Hospital series of laryngeal clefts, describing a further 35 clefts of Benjamin-Inglis types 1 through 3 treated between 1992 and 2003. Associated congenital anomalies were common. Most type 1 and smaller type 2 clefts were repaired endoscopically, whereas larger clefts were repaired through an anterior approach. Increasing use was made recently of a 3-layer repair with an interposition graft of temporalis fascia. The rates of complication, revision surgery, and death were 54%, 26%, and 6%, respectively. Most of the children are now orally fed, and 9 still have a tracheotomy.
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Affiliation(s)
- Haytham Kubba
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, England
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17
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Hartnick CJ, Cotton RT. Congenital laryngeal anomalies. Laryngeal atresia, stenosis, webs, and clefts. Otolaryngol Clin North Am 2000; 33:1293-308. [PMID: 11449788 DOI: 10.1016/s0030-6665(05)70282-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital laryngeal anomalies may occur as a result of defects in normal prenatal development. They are associated with a broad spectrum of symptoms and require treatment ranging from observation alone to complex open airway surgery. The treating otolaryngologist must organize a management strategy focused on timely diagnosis, ensuring a safe airway, and maximum conservation of respiratory, phonatory, and swallowing ability.
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Affiliation(s)
- C J Hartnick
- Department of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, Ohio, USA
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