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Reid AE, Shah S, Towle H, Wehrmann D. A Case of Unsuspected Laryngeal Atresia With Comorbid Tracheoesophageal Fistula and Cardiac Defects. Cureus 2024; 16:e56837. [PMID: 38654782 PMCID: PMC11037875 DOI: 10.7759/cureus.56837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Laryngeal atresia is a rare congenital condition that presents with hypoxia and failed intubation attempts at birth. When diagnosed prenatally, options exist to obtain airway access during delivery. However, postnatal diagnosis requires a high degree of clinical suspicion and the prompt initiation of surgical airway management in order to avoid morbidity and mortality.
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Affiliation(s)
- Abigail E Reid
- Otolaryngology - Head and Neck Surgery, Creighton University School of Medicine, Omaha, USA
| | - Swapnil Shah
- Otolaryngology - Head and Neck Surgery, Creighton University School of Medicine, Omaha, USA
| | - Hunter Towle
- Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Daniel Wehrmann
- Otolaryngology - Head and Neck Surgery, Children's Nebraska, Omaha, USA
- Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, USA
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2
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Soni L, Prasad G, Kaur M. A case of antenatally undiagnosed laryngeal atresia with tracheo-esophageal fistula with airway obstruction at birth and its management. Paediatr Anaesth 2024; 34:175-177. [PMID: 37966468 DOI: 10.1111/pan.14794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Laryngeal atresia is a rare congenital anomaly that is usually diagnosed by antenatal ultrasound, however, if undiagnosed presents with desaturation after birth. A term neonate presented with airway obstruction after birth with multiple failed attempts at intubation and was rescued by proseal laryngeal mask airway (LMA). An esophagoscopy using an Ambuscope utilizing a modified connector assembly revealed an opening on the anterior wall of the esophagus with no esophageal atresia, leading to a diagnosis of H-type tracheo-esophageal fistula (TEF) with laryngeal atresia. The ability to ventilate the neonate via LMA with an absent glottic opening raised the possibility of TEF.
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Affiliation(s)
- Lipika Soni
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ganga Prasad
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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3
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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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4
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Kanamori Y, Tahara K, Ohno M, Tomonaga K, Yamada Y, Hishiki T, Fujino A, Miyazaki O, Nosaka S, Morimoto N, Sugibayashi R, Ozawa K, Wada S, Sago H, Tsukamoto K, Isayama T, Ito Y. Congenital high airway obstruction syndrome complicated with foregut malformation and high airway fistula to the alimentary tract – a case series with four distinct types. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2019-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Congenital high airway obstruction syndrome (CHAOS) is a rare disease and recently has been noticed to show typical prenatal images, such as hyperinflated lungs and flattened or inverted diaphragms. However, in some cases correct diagnosis may be difficult and in such cases the mortality rate increases.
Case presentation
We report four cases of CHAOS complicated with a high airway fistula to the alimentary tract and foregut malformation. The patients did not show the typical features of CHAOS in the fetus. This may be attributed to the high airway fistula acting as a decompression route for the accumulated lung fluids to the alimentary tract.
Conclusion
The combination of CHAOS, foregut malformation and a high airway fistula is very rare and classified into four distinct types: (1) CHAOS with a high airway fistula but not with a foregut malformation; (2) CHAOS with esophageal atresia and tracheoesophageal fistula; (3) CHAOS with a high airway fistula and duodenal atresia; and (4) CHAOS with esophageal atresia, tracheoesophageal fistula and duodenal atresia. It may be useful for treating physicians to be aware of these four distinct types and the typical characteristics of each type.
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Affiliation(s)
- Yutaka Kanamori
- Division of Surgery, Department of Surgical Specialties , National Center for Child Health and Development , 2-10-1 Okura Setagaya-ku , Tokyo 157-8535 , Japan , Tel.: +81-3-3416-0181, Fax: +81-3-3416-2222
| | - Kazunori Tahara
- Division of Surgery, Department of Surgical Specialties , National Center for Child Health and Development , Okura Setagaya-ku , Tokyo , Japan
| | - Michinobu Ohno
- Division of Surgery, Department of Surgical Specialties , National Center for Child Health and Development , Okura Setagaya-ku , Tokyo , Japan
| | - Kotaro Tomonaga
- Division of Surgery, Department of Surgical Specialties , National Center for Child Health and Development , Okura Setagaya-ku , Tokyo , Japan
| | - Yohei Yamada
- Division of Surgery, Department of Surgical Specialties , National Center for Child Health and Development , Okura Setagaya-ku , Tokyo , Japan
| | - Tomoro Hishiki
- Division of Surgery, Department of Surgical Specialties , National Center for Child Health and Development , Okura Setagaya-ku , Tokyo , Japan
| | - Akihiro Fujino
- Division of Surgery, Department of Surgical Specialties , National Center for Child Health and Development , Okura Setagaya-ku , Tokyo , Japan
| | - Osamu Miyazaki
- Department of Radiology , National Center for Child Health and Development , Tokyo , Japan
| | - Shunsuke Nosaka
- Department of Radiology , National Center for Child Health and Development , Tokyo , Japan
| | - Noriko Morimoto
- Division of Otolaryngology, Department of Surgical Specialties , National Center for Child Health and Development , Tokyo , Japan
| | - Rika Sugibayashi
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine , National Center for Child Health and Development , Tokyo , Japan
| | - Katsusuke Ozawa
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine , National Center for Child Health and Development , Tokyo , Japan
| | - Seiji Wada
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine , National Center for Child Health and Development , Tokyo , Japan
| | - Haruhiko Sago
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine , National Center for Child Health and Development , Tokyo , Japan
| | - Keiko Tsukamoto
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine , National Center for Child Health and Development , Tokyo , Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine , National Center for Child Health and Development , Tokyo , Japan
| | - Yushi Ito
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine , National Center for Child Health and Development , Tokyo , Japan
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5
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Causes of death shortly after delivery and medical malpractice claims in congenital high airway obstruction syndrome: Review of the literature. Leg Med (Tokyo) 2019; 40:61-65. [PMID: 31442942 DOI: 10.1016/j.legalmed.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/07/2019] [Accepted: 07/29/2019] [Indexed: 11/23/2022]
Abstract
Congenital High Airway Obstruction Syndrome is a rare pathology that may conduct the baby to death shortly after delivery. This outcome may cause emotional distress in the parents but it may also generate expensive medical malpractice claims about the reasons why the syndrome was not identified and/or correctly treated. The authors conducted a review of the cases in which Congenital High Airway Obstruction Syndrome caused death of the baby shortly after delivery. Then, they pointed out these ultrasonographic and anatomical reasons why the syndrome may be not identified and/or correctly treated: negative prenatal ultrasonography, recurrence of non-specific findings at prenatal ultrasonography, connection of respiratory and gastrointestinal tracts, tracheal agenesis or atresia, parent's refuse of post-partum therapeutic procedures, multiple malformations of the fetus/child. In conclusion, the authors highlighted that death shortly after delivery is usually caused by specific conditions that are not influenced by healthcare team's practice.
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Densmore JC, Oldham KT, Dominguez KM, Berdan ER, McCormick ME, Beste DJ, Amos LB, Lang CA, Woods RK, Kouretas PC, Mitchell ME. Neonatal esophageal trachealization and esophagocarinoplasty in the treatment of flow-limited Floyd II tracheal agenesis. J Thorac Cardiovasc Surg 2019; 153:e121-e125. [PMID: 28526113 DOI: 10.1016/j.jtcvs.2017.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/06/2017] [Indexed: 01/13/2023]
Affiliation(s)
- John C Densmore
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Children's Research Institute, Milwaukee, Wis.
| | - Keith T Oldham
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Children's Research Institute, Milwaukee, Wis
| | | | - Elizabeth R Berdan
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E McCormick
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, Wis
| | - David J Beste
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, Wis
| | - Louella B Amos
- Division of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wis
| | - Cecilia A Lang
- Division of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wis
| | - Ronald K Woods
- Children's Research Institute, Milwaukee, Wis; Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Peter C Kouretas
- Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E Mitchell
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
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Vocal cord dysfunction following esophageal atresia and tracheoesophageal fistula (EA/TEF) repair. J Pediatr Surg 2019; 54:1551-1556. [PMID: 30274710 DOI: 10.1016/j.jpedsurg.2018.08.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/14/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to determine risk factors and long-term outcomes in patients with esophageal atresia +/-tracheoesophageal fistula (EA/TEF) with vocal cord dysfunction (VCD) owing to recurrent laryngeal nerve (RLN) injury. METHOD A retrospective chart review was performed for EA/TEF patients repaired at our institution from 1999 to 2014 (REB #1000032265). RESULTS Of 197 patients, 22 (11.2%) were diagnosed with VCD by indirect laryngoscopy following EA/TEF repair. Aspiration was documented on video swallow study for 21 patients, and as a result, 13 required thickened feeds and 8 required gastrostomy tube feeds. Of the 16 H-type TEF patients, 8 (50%) had VCD. Following discharge, 20 (90.9%) patients with VCD eventually tolerated full feeds orally without aspiration but only 8 (36.4%) had documented recovery of vocal cord movement at long-term follow up (mean 452 days). Overall, patients with VCD were more likely to have feeding modifications, increased exposure to radiological studies, and increased frequency of Otolaryngology follow-up compared to EA/TEF patients without VCD. CONCLUSION EA/TEF patients are at risk for VCD. Clinical improvement did not always correlate with recovery of VC motion. Strategies to minimize RLN damage will improve outcomes and quality of life for EA/TEF patients. LEVEL OF EVIDENCE Level III.
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Korkmaz L, Güneş I, Halis H, Ketenci İ, Baştuğ O, Doğan MS, Akın MA. A case of laryngeal atresia accompanied by persistent pharyngotracheal ductus. Turk Arch Pediatr 2019; 54:57-60. [PMID: 31217712 PMCID: PMC6559978 DOI: 10.5152/turkpediatriars.2018.4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/13/2017] [Indexed: 11/22/2022]
Abstract
Laryngeal atresia is generally a fatal congenital anomaly with an incidence of 1: 50,000 births. This congenital anomaly is a condition of multifactorial inheritance, in which the fetus has a dilated trachea, enlarged echogenic lungs, an inverted or flattened diaphragm, fetal hydrops, and ascites. Diagnosis is usually made when there is failure to perform endotracheal intubation in a neonate with severe respiratory distress and absence of audible cry. Here, we present a very rare case of a newborn with laryngeal atresia who had respiratory distress and was sustained for the first few minutes of life using partial ventilation via a persistent pharyngotracheal duct. We would like to draw the attention of all physicians to this issue by reporting a rare fatal case of a newborn with a congenital presentation.
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Affiliation(s)
- Levent Korkmaz
- Division of Neonatology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Işın Güneş
- Department of Anesthesiology and Reanimation, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Hülya Halis
- Division of Neonatology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - İbrahim Ketenci
- Department of Otolaryngology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Osman Baştuğ
- Division of Neonatology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mehmet Said Doğan
- Department of Radiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mustafa Ali Akın
- Neonatology Unit, Department of Pediatrics Kayseri Training and Research Hospital, Kayseri, Turkey
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9
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Fayoux P, Devisme L. Histoanatomical structures of laryngeal atresia: Functional considerations. Laryngoscope 2019; 130:252-256. [DOI: 10.1002/lary.27855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Pierre Fayoux
- Department of Pediatric Otolaryngology–Head Neck SurgeryJeanne de Flandre Hospital–CHU Lille Lille France
- CERIM EA2694Lille University Lille France
| | - Louise Devisme
- Department of Anatomy and Pathology–CHU Lille Lille France
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10
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Laryngotracheal anomalies associated with esophageal atresia: importance of early diagnosis. Eur Arch Otorhinolaryngol 2018; 275:477-481. [DOI: 10.1007/s00405-017-4856-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
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11
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Airway compromise in the fetus and neonate: Prenatal assessment and perinatal management. Semin Fetal Neonatal Med 2016; 21:230-9. [PMID: 27084444 DOI: 10.1016/j.siny.2016.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The fetus with a potentially obstructed airway can be identified on routine antenatal imaging. These cases should be referred to fetal care centers, which have the necessary expertise to fully evaluate and manage these fetuses and neonates appropriately. Complete airway obstruction may result in fetal hydrops and intrauterine demise. If a newborn infant has a compromised airway at delivery, the inability to secure its airway quickly may result in a hypoxic cerebral insult or death. In the most severely affected cases, prenatal, perinatal, or postnatal surgical intervention may be necessary. The timing of such an intervention will depend on the exact cause of the airway obstruction, other associated findings and the anticipated difficulty in establishing an airway at delivery. Fetal ultrasound and magnetic resonance imaging can differentiate between intrinsic and extrinsic airway obstruction, which allows for the optimal planning and management of the delivery and neonatal resuscitation.
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12
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Ambrosio A, Magit A. Respiratory distress of the newborn: congenital laryngeal atresia. Int J Pediatr Otorhinolaryngol 2012; 76:1685-7. [PMID: 22867518 DOI: 10.1016/j.ijporl.2012.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/11/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
Congenital laryngeal atresia is a rare cause of respiratory distress of the newborn. The defect may be isolated or occur in association with other congenital abnormalities, notably the presence of a tracheoesophageal fistula, esophageal atresia, encephalocele, or Congenital High Airway Obstructive Syndrome (CHAOS). We present the case of a newborn with no identified intrapartum abnormalities with respiratory distress at birth secondary to near-complete laryngeal atresia. Management included tracheostomy, repeated endoscopic incisions, and serial balloon dilatations employing the topical use of Mitomycin C. Seven year follow-up was significant for mobilization of the true vocal cords bilaterally, as well as successful decannulation.
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Affiliation(s)
- Art Ambrosio
- Department of Otolaryngology - Head & Neck Surgery, Naval Medical Center San Diego, CA 92134-2200, United States.
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Vanzati M, Colnaghi M, Vendettuoli V, Weissmann G, Pierro M, Pugni L, Fumagalli M, Mosca F. An unsuspected congenital laryngeal atresia with an associated tracheoesophageal fistula. Paediatr Anaesth 2011; 21:704-6. [PMID: 21518109 DOI: 10.1111/j.1460-9592.2011.03569.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Witters I, Fryns JP, De Catte L, Moerman P. Prenatal diagnosis and pulmonary pathology in congenital high airway obstruction sequence. Prenat Diagn 2009; 29:1081-4. [DOI: 10.1002/pd.2349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cunha MS, Janeiro P, Fernandes R, Carreiro H, Laurini R. Congenital laryngomucocoele: a rare cause for CHAOS. BMJ Case Rep 2009; 2009:bcr07.2008.0595. [PMID: 21686730 DOI: 10.1136/bcr.07.2008.0595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Congenital high airway obstruction syndrome (CHAOS) is a rare but life-threatening condition that results from the obstruction of the upper airways.We describe a female newborn, from a Grávida II, Para 0, 36-year-old woman, with a routine ultrasound at 30 weeks' gestation that showed polyhydramnios. She delivered a live-born female baby at 36 weeks without any dismorphic features but with respiratory distress. Attempts at endotracheal intubation were unsuccessful due to the presence of a mass obstructing the larynx. The reanimation process was stopped after 20 minutes. Post-mortem examination demonstrated the presence of a total occlusion of the larynx by a laryngomucocoele. Laryngocele, a congenital cyst of the larynx, occurs rarely and hardly ever as a cause of CHAOS. What is more, laryngomucocoele has not been previously reported as a cause of CHAOS. These conditions represent a neonatal emergency with reserved prognosis unless diagnosed antenatally allowing for a programmed ex utero intrapartum treatment (EXIT) by performing tracheostomy while maintaining the placental circulation.
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Affiliation(s)
- Manuel Sousa Cunha
- Hospital Fernando Fonseca, Pediatrics, IC 19, Amadora, 2720-276, Portugal
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