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Sittel C, Koitschev A, Schön C, Reiter K. Reconstructive Surgery of the Laryngotracheal Junction. Laryngorhinootologie 2024; 103:S148-S166. [PMID: 38697146 DOI: 10.1055/a-2181-9576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The laryngotracheal junction is an anatomical region with special pathophysiological features. This review presents clinical pictures and malformations that manifest pre-dilectively at this localisation in children and adolescents as well as in adults. The diagnostic procedure is discussed. The possibilities of surgical reconstruction are presented depending on the pathology and age of the patient.
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Affiliation(s)
- Christian Sittel
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Standort Katharinenhospital, Haus D, Allgemeine HNO-Heilkunde, Standort Olgahospital: Pädiatrische HNO-Heilkunde, Otologie
| | - Assen Koitschev
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Standort Katharinenhospital, Haus D, Allgemeine HNO-Heilkunde, Standort Olgahospital: Pädiatrische HNO-Heilkunde, Otologie
| | - Carola Schön
- Kinderklinik der Universität München am Dr. Haunerschen Kinderspital, Klinikum der Universität München, Campus Innenstadt
| | - Karl Reiter
- Kinderklinik der Universität München am Dr. Haunerschen Kinderspital, Klinikum der Universität München, Campus Innenstadt
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2
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Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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3
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El-Sobki A, Baz H, Ibrahim RA, El Deeb ME, El-Kholy NA, Ashraf B, Hashish MI, Negm A. Repair of posterior laryngeal cleft: a 10-year experience in a tertiary referral hospital. J Laryngol Otol 2024; 138:188-195. [PMID: 37073597 DOI: 10.1017/s0022215123000658] [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] [Indexed: 04/20/2023]
Abstract
OBJECTIVE This study aimed to present experience with surgical treatment of laryngeal cleft cases through both open and endoscopic approaches. METHOD A retrospective evaluation of all patients diagnosed as having a laryngeal cleft in a tertiary hospital over 10 years was performed. Pre-operative data, conservative and surgical management of cases, and outcomes were collected, tabulated and analysed. RESULTS This study included 43 patients aged from 2 to 44 months with a median of 9.19 months. Concerning management technique, 12 patients had conservative treatment and the remaining 31 underwent a surgical procedure (of them, 20 patients underwent endoscopic intervention and 11 had the open surgical technique). In the open group, we used either tibial periosteum (six cases) or harvested costal cartilage (five cases). CONCLUSION Surgical management in the form of endoscopic Coblation-assisted or an open approach is indicated in severe cases or mild cases not responding to conservative management.
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Affiliation(s)
- Ahmed El-Sobki
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hemmat Baz
- Phoniatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Reham Ae Ibrahim
- Phoniatrics Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed E El Deeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Noha Ahmed El-Kholy
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Bassem Ashraf
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Menna Ibrahim Hashish
- Pediatrics, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Negm
- Otorhinolaryngology Department, Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt
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4
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Ishii A, Christophel E, Chollet M, Sandu K. Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit. Eur Arch Otorhinolaryngol 2024; 281:283-294. [PMID: 37816841 PMCID: PMC10764377 DOI: 10.1007/s00405-023-08263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE To review the operative techniques, outcomes, and complications following surgery in pediatric patients with laryngo-tracheo-esophageal clefts (LTEC). We describe a new combined approach to treat long LTECs. METHODS Twenty-five patients underwent surgical repair for LTEC from March 2012 to July 2022 at our hospital. Every patient underwent a diagnostic endoscopy under general anesthesia and spontaneous ventilation to assess the LTEC and synchronous aero-digestive comorbidities/malformations. All patients underwent at least one surveillance endoscopy after the repair at our institution. RESULTS The patients had multiple other malformations, specifically gastro-intestinal, synchronous airway, and cardiac. The cleft distribution according to the modified Benjamin and Inglis classification was type I (n = 5, 20%), type II (n = 6, 24%), type IIIa (n = 8, 32%), type IIIb (n = 4, 16%), and type IVa (n = 2, 8%). The median follow-up was 44.6 months. Five patients (20%) had undergone previous cleft corrective surgery(s). Seven patients (28%) had partial to complete breakdown of the repair, needing additional intervention(s), and two required a combined-open plus endoscopic repair. Preoperatively, most patients (n = 18, 72%) needed a feeding assistance. At latest follow-up, feeding assistance was weaned off in 13 out of 18 patients, which was a 72% improvement. Ten patients (40%) needed ventilation assistance before the surgery. Post-operatively, ventilatory assistance was weaned off in 6 patients, meaning a 60% improvement. CONCLUSION LTEC are rare malformations, and their management needs precise diagnosis, appropriate surgical planning, and execution, and dedicated post-operative care. Primary and revision repair of long clefts with tracheal extension may require a combined approach.
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Affiliation(s)
- Alessandro Ishii
- Department of Otorhinolaryngology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emeline Christophel
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
| | - Madeleine Chollet
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
| | - Kishore Sandu
- Department of Otorhinolaryngology, Lausanne University Hospital, Lausanne, Switzerland.
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5
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Sokou R, Batsiou A, Konstantinidi A, Kopanou-Taliaka P, Tsaousi M, Lampridou M, Tavoulari EF, Mitropoulos K, Liakou P, Willadara-Gamage S, Vlastarakos PV, Iliodromiti Z, Boutsikou T, Iacovidou N. Laryngotracheoesophageal Cleft Type IV in a Preterm Neonate. A Case Report and Literature Review. Prague Med Rep 2024; 125:47-55. [PMID: 38380453 DOI: 10.14712/23362936.2024.4] [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] [Indexed: 02/22/2024] Open
Abstract
We present a case of a preterm neonate with a type IV laryngo-tracheo-oesophageal cleft, an uncommon congenital malformation, resulting from the failure of separation of the trachea and the oesophagus during fetal development, often associated with other deformities as well. Data in the literature shows that the long-term morbidity from the entity has declined over the last decades, even though prognosis remains unfavourable for types III and IV. This report emphasizes the complex issues neonatologists are faced with, when treating neonates with this rare disorder in the first days of life, what will raise suspicion of this rare medical entity, and that direct laryngoscopy/bronchoscopy finally depicts the exact extension of the medical condition. At the same time extensive evaluation for coexisting congenital anomalies should be performed. For all the above reasons, these neonates should be treated in specialized tertiary pediatric centers for multidisciplinary prompt management, which may improve, the outcome.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece.
| | - Anastasia Batsiou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | | | - Marina Tsaousi
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | | | - Paraskevi Liakou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | | | - Petros V Vlastarakos
- 2nd ENT Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
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6
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Baker C, Silvernale C, Hartnick C, Zar-Kessler C. Upper Esophageal Sphincter Dysfunction in Children with Type 1 Laryngeal Cleft after Failed Primary Cleft Repair. Biomolecules 2023; 14:15. [PMID: 38275756 PMCID: PMC10813178 DOI: 10.3390/biom14010015] [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: 10/01/2023] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024] Open
Abstract
Changes in pharyngeal and upper-esophageal-sphincter (UES) motor dynamics contribute to swallowing dysfunction. Children with type 1 laryngeal clefts can present with swallowing dysfunction and associated symptoms which may persist even after the initial endoscopic intervention. This study sought to characterize pharyngeal and esophageal motor function in children with type 1 laryngeal clefts who had persistent presenting symptoms after their initial therapeutic intervention. We retrospectively analyzed high-resolution esophageal manometry studies of children ≤ 18 years old with type 1 laryngeal clefts who had an esophageal manometry study performed for persistent symptoms after an initial repair. A total of 16 children were found to have significantly increased UES resting pressure, UES pre- and post-swallow maximum pressures, and duration of UES contraction during swallows in comparison to nine age-matched controls of children without pharyngeal anatomical abnormalities. There was no difference between UES residual pressures or pharyngeal dynamics between the two groups. UES resting and residual pressures did not correlate with VFFS in penetration and aspiration scores of children with type 1 laryngeal clefts status post repair. Our study is the first to identify specific changes in UES motor function in patients with type 1 laryngeal cleft post initial repair.
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Affiliation(s)
- Corey Baker
- Pediatric Gastroenterology, Hepatology and Nutrition, Connecticut Children, Hartford, CT 06106, USA
| | - Casey Silvernale
- Pediatric Gastroenterology, Hepatology and Nutrition, Mass General for Children, Boston, MA 02114, USA (C.Z.-K.)
| | | | - Claire Zar-Kessler
- Pediatric Gastroenterology, Hepatology and Nutrition, Mass General for Children, Boston, MA 02114, USA (C.Z.-K.)
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7
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Krasaelap A, Duncan DR, Sabe RMM, Bhardwaj V, Lerner DG, Gold BD, Boesch RP, Faure C, von Allmen D, Williams D, Chiou E, DeBoer E, Hysinger E, Maybee J, Khlevner J, Larson K, Morris K, Jalali L, McSweeney M, Brigger MT, Greifer M, Rutter M, Williams N, Subramanyan RK, Ryan MJ, Acra S, Pentiuk S, Friedlander J, Sobol SE, Kaul A, Dorfman L, Darbari A, Prager JD, Rosen R, Cocjin JT, Mousa H. Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia. J Pediatr Gastroenterol Nutr 2023; 77:460-467. [PMID: 37438891 DOI: 10.1097/mpg.0000000000003882] [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] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Aerodigestive disorders encompass various pathological conditions affecting the lungs, upper airway, and gastrointestinal tract in children. While advanced care has primarily occurred in specialty centers, many children first present to general pediatric gastroenterologists with aerodigestive symptoms necessitating awareness of these conditions. At the 2021 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the aerodigestive Special Interest Group held a full-day symposium entitled, Pediatric Aerodigestive Medicine: Advancing Collaborative Care of Children with Aerodigestive Disorders. The symposium aimed to underline the significance of a multidisciplinary approach to achieve better outcomes for these complex patients. METHODS The symposium brought together leading experts to highlight the growing aerodigestive field, promote new scientific and therapeutic strategies, share the structure and benefits of a multidisciplinary approach in diagnosing common and rare aerodigestive disorders, and foster multidisciplinary discussion of complex cases while highlighting the range of therapeutic and diagnostic options. In this article, we showcase the diagnostic and therapeutic approach to oropharyngeal dysphagia (OPD), one of the most common aerodigestive conditions, emphasizing the role of a collaborative model. CONCLUSIONS The aerodigestive field has made significant progress and continues to grow due to a unique multidisciplinary, collaborative model of care for these conditions. Despite diagnostic and therapeutic challenges, the multidisciplinary approach has enabled and greatly improved efficient, high-quality, and evidence-based care for patients, including those with OPD.
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Affiliation(s)
- Amornluck Krasaelap
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Mercy Kansas City, Kansas City, MO
| | - Daniel R Duncan
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ramy M M Sabe
- the Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Vrinda Bhardwaj
- the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Diana G Lerner
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Benjamin D Gold
- the Children's Center for Digestive Health Care, LLC, GI Care for Kids, LLC, Aerodigestive Center and Program, Children's Healthcare of Atlanta, Atlanta, GA
| | - Richard Paul Boesch
- the Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, MN
| | - Christophe Faure
- the Division of Pediatric Gastroenterology, Sainte-Justine University Health Center, Université de Montréal, Montréal, QC, Canada
| | - Daniel von Allmen
- the Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dana Williams
- the Department of Pediatric Gastroenterology and Nutrition, Phoenix Children's Hospital, Phoenix, AZ
| | - Eric Chiou
- the Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Emily DeBoer
- the Department of Pediatrics, Section of Pulmonary and Sleep Medicine, Children's Hospital Colorado Breathing Institute, University of Colorado Denver, Aurora, CO
| | - Erik Hysinger
- Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jennifer Maybee
- Children's Hospital Colorado, University of Colorado, Aurora, CO
| | - Julie Khlevner
- the Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY
| | - Kara Larson
- the Division of Otolaryngology, Boston Children's Hospital, Boston, MA
| | - Kimberly Morris
- the Department of Speech Pathology, Rady Children's Hospital, San Diego, CA
| | - Lauren Jalali
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Maireade McSweeney
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Matthew T Brigger
- the Division of Pediatric Otolaryngology, Department of Surgery, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| | - Melanie Greifer
- the Department of Pediatrics, Division of Pediatric Gastroenterology, New York University Grossman School of Medicine, New York, NY
| | - Michael Rutter
- the Division of Pediatric Otolaryngology, Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nina Williams
- the Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA
| | - Ram Kumar Subramanyan
- the University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE
| | - Matthew J Ryan
- the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sari Acra
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Scott Pentiuk
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Steven E Sobol
- the Division of Otolaryngology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ajay Kaul
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lev Dorfman
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Anil Darbari
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jeremy D Prager
- the Department of Otolaryngology, University of Colorado School of Medicine; Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO
| | - Rachel Rosen
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jose T Cocjin
- the Division of Pediatric Gastroenterology, Sainte-Justine University Health Center, Université de Montréal, Montréal, QC, Canada
| | - Hayat Mousa
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Nakatani E, Terui K, Nakata M, Komatsu S, Shibata R, Oita S, Kawaguchi Y, Takenouchi A, Harada-Kagitani S, Kishimoto T, Fukumoto K, Hishiki T. Gastric tumor mimicking bronchial tissue associated with a laryngotracheoesophageal cleft: a case report. Surg Case Rep 2023; 9:72. [PMID: 37156975 PMCID: PMC10167068 DOI: 10.1186/s40792-023-01650-7] [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: 03/14/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Laryngotracheoesophageal cleft (LTEC) is a rare disease in which the larynx and trachea communicate posteriorly to the esophagus. It is often associated with other congenital malformations, particularly gastrointestinal anomalies. Herein, we report a case of LTEC associated with a gastric polypoid lesion in bronchial tissue. CASE PRESENTATION A gastric mass was detected in a male fetus since week 21 of gestation using fetal ultrasonography. Esophagogastroduodenoscopy performed after birth revealed a pedunculated polypoid lesion of the gastric fornix. The patient experienced frequent vomiting and aspiration pneumonia, which persisted after nasoduodenal tube feeding. Communication between the airway and esophagus was suspected. Laryngoscopy performed 30 days later revealed an LTEC (type III). Partial gastrectomy was performed when the patient was 93 days of age. Histopathological examination revealed tumor consisting of cartilage tissue covered with a layer of respiratory epithelium. CONCLUSION The gastric tumor associated with LTEC exhibited structures mimicking bronchial tissue. LTEC occurs because of foregut maldevelopment, and the tumorous respiratory tissue in the stomach may have been formed from the same abnormal foregut development event as LTEC.
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Affiliation(s)
- Erika Nakatani
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Surgery, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Mitsuyuki Nakata
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shugo Komatsu
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ryohei Shibata
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Satoru Oita
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yunosuke Kawaguchi
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | | | - Takashi Kishimoto
- Department of Molecular Pathology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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9
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Stammer A, Sutton L, Ghedia R, Thavagnanam S, Orban N. Combined otolaryngology and respiratory airway endoscopy for complex paediatric airway patients: A prospective qualitative review of 20 patients. Clin Otolaryngol 2023. [PMID: 36914381 DOI: 10.1111/coa.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/30/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Adam Stammer
- Department of Medicine, Queen Mary University of London, London, UK
| | - Liam Sutton
- Department of ENT, Royal London Hospital, London, UK
| | - Reshma Ghedia
- Department of ENT, Royal London Hospital, London, UK
| | - Surendran Thavagnanam
- Department of Medicine, Queen Mary University of London, London, UK.,Department of Paediatric Respiratory Medicine, Royal London Hospital, London, UK
| | - Nara Orban
- Department of Medicine, Queen Mary University of London, London, UK.,Department of ENT, Royal London Hospital, London, UK
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10
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Anatomy and embryology of tracheo-esophageal fistula. Semin Pediatr Surg 2022; 31:151231. [PMID: 36459913 DOI: 10.1016/j.sempedsurg.2022.151231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Anomalies in tracheo-esophageal development result in a spectrum of congenital malformations ranging from, most commonly, esophageal atresia with or without trachea-esophageal fistula (EA+/-TEF) to esophageal web, duplication, stricture, tracheomalacia and tracheal agenesis. Despite the relative frequency of EA, however, the underlying etiology remains unknown and is likely due to a combination of genetic, epigenetic and environmental factors. In recent years, animal models have dramatically increased our understanding of the molecular and morphological processes involved in normal esophageal development during the key stages of anterior-posterior regionalization, dorsal-ventral patterning and morphogenic separation. Moreover, the use of animal models in conjunction with increasingly advanced techniques such as genomic sequencing, sophisticated live imaging studies and organoid models have more recently cast light on potential mechanisms involved in EA pathogenesis. This article aims to unravel some of the mysteries behind the anatomy and embryology of EA whilst providing insights into future directions for research.
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11
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Ramachandran J, Zhou W, Bardenhagen AE, Nasr T, Yates ER, Zorn AM, Ji H, Vokes SA. Hedgehog regulation of epithelial cell state and morphogenesis in the larynx. eLife 2022; 11:e77055. [PMID: 36398878 PMCID: PMC9718526 DOI: 10.7554/elife.77055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
The larynx enables speech while regulating swallowing and respiration. Larynx function hinges on the laryngeal epithelium which originates as part of the anterior foregut and undergoes extensive remodeling to separate from the esophagus and form vocal folds that interface with the adjacent trachea. Here we find that sonic hedgehog (SHH) is essential for epithelial integrity in the mouse larynx as well as the anterior foregut. During larynx-esophageal separation, low Shh expression marks specific domains of actively remodeling epithelium that undergo an epithelial-to-mesenchymal transition (EMT) characterized by the induction of N-Cadherin and movement of cells out of the epithelial layer. Consistent with a role for SHH signaling in regulating this process, Shh mutants undergo an abnormal EMT throughout the anterior foregut and larynx, marked by a cadherin switch, movement out of the epithelial layer and cell death. Unexpectedly, Shh mutant epithelial cells are replaced by a new population of FOXA2-negative cells that likely derive from adjacent pouch tissues and form a rudimentary epithelium. These findings have important implications for interpreting the etiology of HH-dependent birth defects within the foregut. We propose that SHH signaling has a default role in maintaining epithelial identity throughout the anterior foregut and that regionalized reductions in SHH trigger epithelial remodeling.
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Affiliation(s)
- Janani Ramachandran
- Department of Molecular Biosciences, The University of Texas at AustinAustinUnited States
| | - Weiqiang Zhou
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public HealthBaltimoreUnited States
| | - Anna E Bardenhagen
- Department of Molecular Biosciences, The University of Texas at AustinAustinUnited States
| | - Talia Nasr
- Center for Stem Cell and Organoid Medicine (CuSTOM), Division of Developmental Biology, and Perinatal Institute, Cincinnati Children’s Hospital Medical CenterCincinnatiUnited States
- Department of Pediatrics, University of Cincinnati College of MedicineCincinnatiUnited States
| | - Ellen R Yates
- Department of Molecular Biosciences, The University of Texas at AustinAustinUnited States
| | - Aaron M Zorn
- Center for Stem Cell and Organoid Medicine (CuSTOM), Division of Developmental Biology, and Perinatal Institute, Cincinnati Children’s Hospital Medical CenterCincinnatiUnited States
- Department of Pediatrics, University of Cincinnati College of MedicineCincinnatiUnited States
| | - Hongkai Ji
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public HealthBaltimoreUnited States
| | - Steven A Vokes
- Department of Molecular Biosciences, The University of Texas at AustinAustinUnited States
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12
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McCollum N, Agrawal D. Don't go barking up the wrong tree: Thinking beyond infection in a toddler with stridor. Am J Emerg Med 2022; 62:149.e1-149.e4. [PMID: 36182581 DOI: 10.1016/j.ajem.2022.09.016] [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: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022] Open
Abstract
A toddler presented to the emergency department with persistent stridor and barky cough for 4 weeks and progressive dysphagia for 1 week. During this time, he had sought medical attention 6 additional times and had been treated for pneumonia, wheezing and croup, receiving antibiotics and several courses of steroids without improvement. On the final presentation, airway imaging did not reveal a foreign body. However, bedside laryngoscopy demonstrated bilateral vocal cord paralysis. Further imaging revealed an intracranial posterior fossa mass which provided the unifying diagnosis for his persistent symptoms.
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Affiliation(s)
- Nichole McCollum
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States of America; The George Washington School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052, United States of America.
| | - Dewesh Agrawal
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States of America; The George Washington School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052, United States of America
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13
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Airway abnormalities associated with congenital heart disease. Pediatr Radiol 2022; 52:1849-1861. [PMID: 35778574 DOI: 10.1007/s00247-022-05429-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/07/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
Airway abnormalities are important but sometimes overlooked problems in children with congenital heart disease. It is often difficult to separate symptoms related to cardiac disease from those associated with airway or lung disease. Some of the lesions are incidental while others cause significant symptoms and are important in overall functional outcome. Congenital and acquired as well as intrinsic and extrinsic lesions occur and can overlap. We review and illustrate these lesions here. Imaging plays a crucial role in diagnosing and assessing the severity of airway abnormalities and guiding medical and surgical management decisions.
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14
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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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15
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García-Muro C, Sáenz-Moreno I, Gómez-Sáez F, Navazo-Eguia A. Type 2 laryngeal cleft associated with OpitzG/BBB syndrome. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:196-198. [DOI: 10.1016/j.otoeng.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/02/2021] [Indexed: 11/25/2022]
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16
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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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17
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Mattos C, Phinizy P, Duffy KL, Sobol S, Piccione J. Clinical predictors of laryngotracheoesophageal clefts and tracheoesophageal fistulae in children with dysphagia. Pediatr Pulmonol 2021; 56:3792-3795. [PMID: 34387933 DOI: 10.1002/ppul.25628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
UNLABELLED Laryngotracheoesophageal clefts (LTECs) and tracheoesophageal fistulae (TEF) are important structural causes of aspiration requiring bronchoscopy for diagnosis. Determining which children are at greatest risk for LTEC and TEF would enable clinicians to be more selective in performing bronchoscopy. METHODS Medical records of children aged 0-18 years who underwent flexible and rigid bronchoscopy for evaluation of dysphagia with aspiration were collected and analyzed to identify predictors of LTEC and TEF. RESULTS Seventy-two children age 2 months to 9 years were identified. LTEC was identified in 19 (26%) and TEF was identified in 1 (1.3%). One-third of the cohort was born preterm (median gestational age 34 weeks). The proportion of LTEC in those born preterm was lower than that of those born full-term (12% vs. 34%, p = .03). There was no statistically significant difference in LTEC prevalence based on age, midline defects, laryngomalacia, tracheomalacia, history of TEF repair, silent aspiration, or viscosity of barium aspirated during videofluoroscopic swallowing studies. Bronchoalveolar lavage fluid cytology, lipid-laden macrophage proportions, and culture results were similar among those with and without LTEC. CONCLUSION Children with dysphagia and tracheal aspiration born full-term are three times more likely to have LTEC than those born preterm. Dysphagia in children with a history of preterm birth is more likely to be functional as opposed to structural, however, LTEC was identified in approximately 10% of these children and must be considered. These results support the role of bronchoscopy in children with dysphagia with tracheal aspiration.
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Affiliation(s)
- Claudia Mattos
- Department of Pediatrics, Nicklaus Children's Hospital, Coral Terrace, Florida, USA
| | - Pelton Phinizy
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kimberly L Duffy
- Department of Speech-Language Pathology, Center for Childhood Communication, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven Sobol
- Division of Otolaryngology, Department of Otorhinolaryngology-Head & Neck Surgery, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joseph Piccione
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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18
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Chang DR, Londino AV, Barnett N. Multidisciplinary management of a neonate in respiratory distress with undiagnosed type IV laryngeal cleft. J Clin Anesth 2021; 76:110564. [PMID: 34695750 DOI: 10.1016/j.jclinane.2021.110564] [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] [Received: 09/08/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel R Chang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave 8(th) Floor, New York, NY 10029, United States
| | - Aldo V Londino
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
| | - Natalie Barnett
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 10 McClennan Banks Dr, Charleston, SC 29425, United States.
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19
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García-Muro C, Sáenz-Moreno I, Gómez-Sáez F, Navazo-Eguía A. Type 2 laryngeal cleft associated with OpitzG/BBB syndrome. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(21)00090-X. [PMID: 34404523 DOI: 10.1016/j.otorri.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/14/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Fernando Gómez-Sáez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario de Burgos, Burgos, España
| | - Ana Navazo-Eguía
- Servicio de Otorrinolaringología, Hospital Universitario de Burgos, Burgos, España
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20
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Menon SM, Chandramati J, Prabhu AS, Ponthenkandath S. Asymptomatic severe laryngotracheoesophageal cleft (LTEC) in a preterm newborn. CASE REPORTS IN PERINATAL MEDICINE 2021. [DOI: 10.1515/crpm-2020-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
We are presenting a unique case of severe laryngo-tracheo-esophageal cleft in a preterm infant who remained asymptomatic for several days after birth. Laryngo-tracheo-esophageal cleft (LTEC) is a rare congenital anomaly, representing approximately 0.2–1.5% of congenital laryngeal malformations [Merei JM, Hutson JM. Embryogenesis of tracheo esophageal anomalies: a review. Pediatr Surg Int 2002;18:319–26]. There is an abnormal, posterior, sagittal communication between the larynx and the pharynx, which may extend downward between the trachea and the esophagus.
Case presentation
We report a case of LTEC in a preterm newborn whose mother had severe polyhydramnios. A preterm 34-week gestation female newborn was born in our institution whose mother had severe polyhydramnios during third trimester. She was postnatally diagnosed to have type 3 LTEC by the 19th day after birth. In the presence of a large common tracheo-esophageal cavity, the baby did not develop aspiration or respiratory distress despite feeding from birth.
Conclusions
This case report illustrates the many factors and the probable mechanisms involved in preventing aspiration.
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Affiliation(s)
- Smriti M. Menon
- Department of Neonatology , Amrita Institute of Medical Sciences, Amrita Viswavidyapeetam , Kochi , India
| | - Jayasree Chandramati
- Department of Neonatology , Amrita Institute of Medical Sciences, Amrita Viswavidyapeetam , Kochi , India
| | - Ashwin S. Prabhu
- Department of Neonatology , Amrita Institute of Medical Sciences, Amrita Viswavidyapeetam , Kochi , India
| | - Sasidharan Ponthenkandath
- Department of Neonatology , Amrita Institute of Medical Sciences, Amrita Viswavidyapeetam , Kochi , India
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21
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Seidl E, Kramer J, Hoffmann F, Schön C, Griese M, Kappler M, Lisec K, Hubertus J, von Schweinitz D, Di Dio D, Sittel C, Reiter K. Comorbidity and long-term clinical outcome of laryngotracheal clefts types III and IV: Systematic analysis of new cases. Pediatr Pulmonol 2021; 56:138-144. [PMID: 33095514 DOI: 10.1002/ppul.25133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 10/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Long segment laryngotracheoesophageal clefts (LTECs) are very rare large-airway malformations. Over the last 40 years mortality rates declined substantially due to improved intensive care and surgical procedures. Nevertheless, long-term morbidity, comorbidity, and clinical outcomes have rarely been assessed systematically. METHODS In this retrospective case series, the clinical presentation, comorbidities, treatment, and clinical outcomes of all children with long-segment LTEC that were seen at our department in the last 15 years were collected and analyzed systematically. RESULTS Nine children were diagnosed with long segment LTEC (four children with LTEC type III and five patients with LTEC type IV). All children had additional tracheobronchial, gastrointestinal, or cardiac malformations. Tracheostomy for long-time ventilation and jejunostomy for adequate nutrition was necessary in all cases. During follow-up one child died from multiorgan failure due to sepsis at the age of 43 days. The clinical course of the other eight children (median follow-up time 5.2 years) was stable. Relapses of the cleft, recurrent aspirations, and respiratory tract infections led to repeated hospital admissions. CONCLUSIONS Long-segment LTECs are consistently associated with additional malformations, which substantially influence long-term morbidity. For optimal management, a multidisciplinary approach is essential.
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Affiliation(s)
- Elias Seidl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Johanna Kramer
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Carola Schön
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Kappler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kristina Lisec
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Diana Di Dio
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Christian Sittel
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Karl Reiter
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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22
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Dombrowski ND, Li Y, Zhao CX, Agrawal PB, Rahbar R. Familial and genetic factors in laryngeal cleft: Have we learned anything? Int J Pediatr Otorhinolaryngol 2020; 138:110283. [PMID: 32771712 DOI: 10.1016/j.ijporl.2020.110283] [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: 04/15/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Laryngeal clefts are rare congenital anomalies characterized by failed fusion of the posterior cricoid lamina or incomplete development of the tracheoesophageal septum. While most cases are sporadic, laryngeal cleft may be associated with other congenital anomalies or syndromes. Though not frequently reported, familial occurrence of laryngeal cleft has been noted in our clinical experience. The goal of this research is to describe the existing literature and our own experience surrounding familial occurrence of laryngeal cleft that may help elucidate its underlying genetic basis. METHODS Comprehensive literature search was conducted and retrospective chart review was performed on 8 sets of siblings diagnosed at our institution. Data assessed included demographics, type of cleft, and genetic findings. RESULTS Laryngeal cleft appears to be mostly sporadic. We evaluated data at our institution over a 10-year period and identified 19 patients from 8 families demonstrating familial occurrence of laryngeal cleft. Six (75%) families had two affected siblings, one family (12.5%) had three affected siblings, and one family (12.5%) had four affected siblings. There was no evidence of sex predilection, with half the patients being male (10/19, 52.6%). Fourteen patients (73.7%) had Type 1 clefts and five (26.3%) had Type 2 clefts. Genetic findings were available for review in five patients from three families. CONCLUSION Beyond a few known syndromes, laryngeal cleft has largely been thought to be sporadic. However, findings from the existing literature and our own experience with familial laryngeal cleft in eight families suggest additional genetic factors are yet to be elucidated.
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Affiliation(s)
- Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Youjin Li
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Cher X Zhao
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Pankaj B Agrawal
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA; Divisions of Newborn Medicine and Genetics & Genomics, The Manton Center for Orphan Disease Research, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA.
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23
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Harris VC, Dalesio NM, Clark J, Nellis JC, Tunkel DE, Lee AH, Skinner M. Postoperative respiratory complications and disposition in patients with type 1 laryngeal clefts undergoing injection or repair - A single institution experience. Int J Pediatr Otorhinolaryngol 2020; 131:109844. [PMID: 31901483 DOI: 10.1016/j.ijporl.2019.109844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Identify incidence and factors associated with respiratory complications after type 1 cleft repair. METHODS Retrospective chart review of patients who underwent cleft repair over a 5-year period performed by a single surgeon. Primary endpoint was respiratory complications (oxygen desaturation <90%). Fisher's exact test was used to identify differences between repair types (endoscopic carbon dioxide laser-assisted repair and injection laryngoplasty). Logistic regression was used to identify predictors of respiratory events. RESULTS Fifty-five patients were included. Thirty-four (62%) patients underwent endoscopic carbon dioxide laser-assisted repair and 21 (38%) underwent injection laryngoplasty. Average hospital stay for each group was 1.6 days (SD = 3.1) and 0.6 days (SD = 0.9), respectively. Desaturations occurred in three patients (9%) in the laser-assisted repair group and one patient (4%) in the injection group. All occurred within 3 h after surgery and resolved with supplemental oxygen, oral airway placement, and/or mask ventilation. Two affected patients had comorbid diagnosis of asthma (one had poor medication compliance), and one had a history of developmental delay and hypotonia. In the injection group, desaturations occurred in one patient with a history of tracheal stenosis and double aortic arch. No correlation existed between repair type and desaturation (p = 0.57). No variables were significant predictors of events. CONCLUSIONS In this cohort, respiratory events after type 1 laryngeal cleft repair occurred early in the postoperative period, in children with cardiac and pulmonary comorbidities. This suggests postoperative admission may only be necessary for a select group of patients undergoing type 1 cleft repair. However, further research is needed to determine criteria for same-day discharge.
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Affiliation(s)
- Vandra C Harris
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Nicholas M Dalesio
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - James Clark
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jason C Nellis
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - David E Tunkel
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrew H Lee
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Margaret Skinner
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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24
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Li Y, Rui X, Li N. Genetic factors in isolated and syndromic laryngeal cleft. Paediatr Respir Rev 2020; 33:24-27. [PMID: 31734186 DOI: 10.1016/j.prrv.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/31/2019] [Accepted: 09/07/2019] [Indexed: 11/29/2022]
Abstract
A laryngotracheoesophageal cleft (LC) is a rare congenital anomaly of the upper aerodigestive tract resulting from the absence of fusion of the posterior cricoid lamina, which affects an abnormal communication between the larynx, trachea and esophagus. The genetic etiology of LC remains elusive. The involvement of genetic factors in the development of LC is suggested by reports of familial occurrence, and the increased prevalence of component features among first-degree relatives of affected individuals and murine knockout models. No consistent pattern of inheritance has been found in nonsyndromic patients, except for cases associated with described syndromes. Once the syndrome related to the laryngeal cleft is considered, an active search for the cleft must be initiated. The genetic evaluation of patients with LCs should be guided by the type and location of the malformation, specific medical history and a detailed physical examination. The application of genetic approaches, such as microarrays and exome sequencing might lead to elucidating the etiology of LCs.
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Affiliation(s)
- Youjin Li
- Department of Otorhinolaryngology-Head & Neck Surgery, Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
| | - Xiaoqing Rui
- Department of Otorhinolaryngology-Head & Neck Surgery, Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Niu Li
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
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25
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Abstract
Congenital or acquired disorders of the pediatric airway can affect the upper, lower, or entire airway. There are fundamental differences between the anatomy and physiology of the neonate, pediatric, and adult airways. Infants are not merely small adults in this respect and size, surface area, proportion, resistance, and compliance vary greatly between the age groups. A clear understanding of these significant differences and how they affect patients dependent on age is key to appropriate management.
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Affiliation(s)
- Shyan Vijayasekaran
- Faculty of Medicine and health sciences, University of Western Australia, Perth, WA, Australia.,Department of Otolaryngology Head and Neck Surgery, Perth Children's hospital, Nedlands, WA, Australia
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Manning A, Wehrmann DJ, Hart CK, Green GE. Innovations in Airway Surgery. Otolaryngol Clin North Am 2019; 52:923-936. [DOI: 10.1016/j.otc.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Repair of type IV laryngotracheoesophageal cleft (LTEC) on ECMO. Pediatr Surg Int 2019; 35:565-568. [PMID: 30783751 DOI: 10.1007/s00383-019-04455-8] [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] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A type IV laryngotracheoesophageal cleft (LTEC) is a very rare congenital malformation. Type IV LTEC that extends to the carina have poor prognosis and are difficult to manage. We present our experience with surgical repair in such a case using extracorporeal membranous oxygenation (ECMO). METHODS A male infant, who was diagnosed with Goldenhar syndrome, showed severe dyspnea and dysphagia. Laryngoscopy indicated the presence of LTEC. The patient was transferred to our institute for radical operation 26 days after birth. Prior to surgery, a balloon catheter was inserted in the cardiac region of stomach through the lower esophagus to block air leakage, to maintain positive pressure ventilation. We also performed observations with a rigid bronchoscope to assess extent of the cleft, and diagnosed the patient with type IV LTEC. After bronchoscopy, we could intubate the tracheal tube just above the carina. Under ECMO, repair of the cleft was performed by an anterior approach via median sternotomy. RESULTS The patient was intubated via nasotracheal tube and paralysis was maintained for 2 weeks, using a muscle relaxant for the first 3 days. Two weeks after surgery, rigid bronchoscopy showed that the repair had been completed, and the tracheal tube was successfully extubated without tracheotomy. CONCLUSIONS Although insertion of a balloon catheter is a very simple method, it can separate the respiratory and digestive tracts. This method allowed for positive pressure ventilation and prevented displacement of the endotracheal tube until ECMO was established. As a result, we safely performed the operation and the post-operative course was excellent.
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Chen J, Stern J, Neuman J, Koshy J. A rare case of laryngeal cleft in association with VACTERL and malrotation. Radiol Case Rep 2019; 14:315-319. [PMID: 30546815 PMCID: PMC6287062 DOI: 10.1016/j.radcr.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 11/16/2022] Open
Abstract
We report a rare case of a neonatal girl who presented with coughing and dyspnea immediately after feeds. At birth, she was noted to have an imperforate anus with a posterior fourchette fistula from which she was stooling. Initial imaging with radiography showed a normal bowel gas pattern; however, lumbar vertebral anomalies were noted. An upper GI series was performed and revealed a laryngeal cleft and malrotation. Ultrasound confirmed malrotation with an abnormal SMA-SMV relationship. Since laryngeal cleft is a rare condition and may not be known to most radiologists, its incidence is likely underestimated. It is important to note the association of laryngeal clefts with VACTERL and malrotation. In addition, it is essential not to confuse a laryngeal cleft with a tracheoesophageal fistula since the management differs.
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Abstract
Diagnosis and treatment of laryngeal clefts (LCs) particularly type I pose a challenge. Although rare, type I LCs are becoming increasingly identified in recent years, and this is perhaps due to both an increased awareness and better diagnostic modalities. We report a young infant presenting with feeding difficulty and respiratory distress related to LC. The pertinent literature is also reviewed.
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Miller AL, Hersh CJ, Johnson KE, Hartnick CJ. Short-term swallowing outcomes following type 1 laryngeal cleft injection. Int J Pediatr Otorhinolaryngol 2019; 116:159-163. [PMID: 30554689 DOI: 10.1016/j.ijporl.2018.10.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/16/2018] [Accepted: 10/28/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Interarytenoid injection augmentation at the time of initial diagnostic endoscopy for aspiration and dysphagia may result in near-immediate improvement in swallowing function, potentially obviating the need for future formal endoscopic repair of type 1 laryngeal cleft. Interarytenoid injection augmentation may also address physiologic aspiration. Early treatment of type 1 laryngeal cleft may allow for expedited liberalization of feedings. The objective of this study was to evaluate the effect of interarytenoid injection augmentation (IIA) for type 1 laryngeal clefts (LC-1) on short-term swallowing function assessed by videofluoroscopic swallowing study (VFSS). METHODS This was a retrospective cohort study of patients age ≤24 months with dysphagia on preoperative VFSS who underwent IIA with calcium hydroxyapatite for LC-1 during direct laryngoscopy and bronchoscopy from June to October 2017 at a tertiary care academic subspecialty hospital. Exclusion criteria included prior endoscopic or open LC repair (n = 1), gastrostomy tube dependence (n = 1), additional procedures at the time of IIA (supraglottoplasty, frenulectomy, n = 1). Children without postoperative VFSS within 30 days of injection were excluded (n = 2). Fifteen children met inclusion criteria for analysis. The primary endpoint was improvement in safely swallowed consistency as defined by recommendation to liberalize diet by at least a half-consistency (e.g. half-honey to nectar thick liquid). Secondary endpoints included clinical assessment of dysphagia and postoperative respiratory events. RESULTS Median [range] age at injection was 15.2 [7.7-24.3] months and 67% of patients were female (n = 10). The majority (13/15) of patients were full-term and 80% of patients (n = 12) had documented gastroesophageal reflux disease (GERD). Median time from injection to VFSS was 16 [9-29] days. Improvement in safely swallowed consistency was noted in 60% (n = 9) of patients. Aspiration completely resolved in two patients. Swallow function was unchanged in 40% of patients (n = 6); no patients experienced worsening dysphagia. No respiratory complications were documented during inpatient observation. CONCLUSION IIA is a safe procedure that may result in immediate improvement in dysphagia in select patients with LC-1. IIA does not address neurologic, developmental, or other anatomic etiologies of dysphagia. Additional studies are required to determine long-term efficacy of IIA on dysphagia and pulmonary complications, as well as the patient- and caregiver-related outcome measures.
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Affiliation(s)
- Ashley L Miller
- Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA, USA
| | - Cheryl J Hersh
- Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA, USA; Massachusetts General Hospital for Children, Boston, MA, USA
| | - Kaalan E Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, USA; Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's, Seattle, WA, USA
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Bruhat C, Briac T, Delabaere A, Labbé A, Lémery D, Laurichesse-Delmas H, Gallot D. Laryngotracheoesophageal cleft, a rare differential diagnosis of esophageal atresia. J Gynecol Obstet Hum Reprod 2018; 47:577-579. [DOI: 10.1016/j.jogoh.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022]
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Type IV Laryngotracheoesophageal Cleft Associated with Type III Esophageal Atresia in 1p36 Deletions Containing the RERE Gene: Is There a Causal Role for the Genetic Alteration? Case Rep Pediatr 2018; 2018:4060527. [PMID: 30245899 PMCID: PMC6136558 DOI: 10.1155/2018/4060527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/09/2018] [Accepted: 08/01/2018] [Indexed: 01/02/2023] Open
Abstract
The causes of embryological developmental anomalies leading to laryngotracheoesophageal clefts (LTECs) are not known, but are proposed to be multifactorial, including genetic and environmental factors. Haploinsufficiency of the RERE gene might contribute to different phenotypes seen in individuals with 1p36 deletions. We describe a neonate of an obese mother, diagnosed with type IV LTEC and type III esophageal atresia (EA), in which a 1p36 deletion including the RERE gene was detected. On the second day of life, a right thoracotomy and extrapleural esophagus atresia repair were attempted. One week later, a right cervical approach was performed to separate the cervical esophagus from the trachea. Three months later, a thoracic termino-terminal anastomosis of the esophagus was performed. An anterior fundoplication was required at 8 months of age due to severe gastroesophageal reflux and failure to thrive. A causal role of 1p36 deletions including the RERE gene in the malformation is proposed. Moreover, additional parental factors must be considered. Future studies are mandatory to elucidate genomic and epigenomic susceptibility factors that underlie these congenital malformations. A multiteam approach is a crucial factor in the successful management of affected patients.
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Laryngeal cleft type IV: One pathology, two different presentations. Int J Pediatr Otorhinolaryngol 2018; 109:154-157. [PMID: 29728171 DOI: 10.1016/j.ijporl.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 11/24/2022]
Abstract
Laryngotracheoesophageal cleft is a rare congenital malformation where a communication exists between the aero-digestive tracts that is associated with high morbidity and mortality. In this case series, we describe our experience with two neonates evaluated in our institution with two diverse initial presentations and symptomatology of type IV laryngotracheoesophageal clefts. One patient presented with acute distress and respiratory failure due to bowel contents obstructing the trachea and the other presented with mild subcostal retractions and inspiratory stridor without overt respiratory failure. Most importantly, not every patient with type IV laryngotracheoesophageal clefts will present with fulminant respiratory difficulty. This prompted a literature review.
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Irace AL, Walker RD, Kawai K, Maddock M, Dombrowski ND, Sideridis G, Ferrari L, Rahbar R. Development and validation of a quality of life instrument for patients with laryngeal cleft. Int J Pediatr Otorhinolaryngol 2018; 108:143-150. [PMID: 29605344 DOI: 10.1016/j.ijporl.2018.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/09/2018] [Accepted: 02/25/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop and validate a novel pediatric health-related quality of life (HR-QoL) instrument for patients with laryngeal cleft and their families. METHODS We surveyed primary caregivers of patients that underwent endoscopic repair of Type I or II laryngeal cleft. The proposed HR-QoL instrument consists of 40 items representing four domains, assessing the patient's physical symptoms, the patient's and family's social functioning, and the family's emotions regarding the patient's illness pre- and post-operatively. Confirmatory factor analysis was employed to assess construct validity, dimensionality, and optimal simple structure. RESULTS Of 78 eligible participants reached by phone, 40 (51%) of them completed the questionnaire. Confirmatory factor analysis suggested that all four measured constructs were well supported by the measured items in comparison to a unidimensional model. All factor loadings and factor correlations were significant and factor correlations ranged between 0.723 and 0.879. Indices of test-retest reliability and internal consistency reliability were well above recommended standards. There was a significant correlation between current instrument and PedsQL™ score. The overall QoL score significantly improved from 112.3 (±28.1) before surgery to 158.0 (±28.5) after surgery (mean difference 45.7; 95% CI: 37.3, 54.1; p < 0.001). CONCLUSION Our proposed pediatric HR-QoL instrument is a valid tool for measuring quality of life in patients with laryngeal cleft and their families. This instrument can provide insight into the effects of medical and surgical therapy and guide pre- and post-operative management of laryngeal cleft.
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Affiliation(s)
- Alexandria L Irace
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States
| | - Ryan D Walker
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States
| | - Kosuke Kawai
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States; Department of Otolaryngology, Harvard Medical School, United States
| | - Meaghan Maddock
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States
| | - Georgios Sideridis
- Clinical Research Center, Boston Children's Hospital, Harvard Medical School, United States
| | - Lynne Ferrari
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, United States; Department of Anaesthesia, Harvard Medical School, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States; Department of Otolaryngology, Harvard Medical School, United States.
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Management of laryngeal cleft in mechanically ventilated children with severe comorbidities. Auris Nasus Larynx 2018; 45:1121-1126. [PMID: 29673563 DOI: 10.1016/j.anl.2018.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/20/2022]
Abstract
Laryngeal clefts are rare congenital malformations of the posterior part of the larynx. The severities are correlated with the downward extension of the cleft and can involve numerous clinical symptoms including dysphagia and respiratory distress. As significant comorbidities may be present, individual treatments depend on the child's general condition and type of cleft involved. Herein, we describe two cases of children with laryngeal clefts and severe comorbidities requiring mechanical ventilation. One child with type III laryngeal cleft was successfully managed with the lateral pharyngotomy approach. The other child with type II laryngeal cleft has not been able to undergo cleft-closure surgery because of severe general conditions, therefore has continued training for feeding and swallowing.
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Sobol SE. Diagnosis and Management of Laryngotracheoesophageal Cleft. Curr Probl Pediatr Adolesc Health Care 2018; 48:82-84. [PMID: 29571545 DOI: 10.1016/j.cppeds.2018.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Laryngotracheoesophageal cleft (LTEC) is a rare anatomic cause of aspiration in the newborn and infant. The clinical presentation of infants with LTEC is variable and will usually vary with the degree of anatomic communication between the airway and esophagus. The diagnosis of LTEC is often challenging, particularly in cases where the presentation and pathology are more subtle. Management of LTEC depends upon the clinical presentation, degree of aspiration, and anatomic depth of the cleft. The goal of this review is to present the clinician with a practical approach to diagnosis and management of this rare but challenging congenital airway anomaly.
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Affiliation(s)
- Steven E Sobol
- Division of Otolaryngology, Center for Pediatric Airway Disorders, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
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Pediatric Swallowing Function in the Presence of Laryngeal Cleft and Laryngomalacia: a Review of the Literature. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0178-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khaleghnejad A, Sadr S, Tabatabaei SA, Farahbakhsh N, Dabirmoghaddam P, Mansori SS. Laryngotracheoesophageal Cleft Type 3 and Severe Laryngotracheomalacia; Delayed Surgical Repair, a Treatment Challenge with an Excellent Outcome. Respir Med Case Rep 2017; 23:26-28. [PMID: 29201636 PMCID: PMC5699882 DOI: 10.1016/j.rmcr.2017.10.007] [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: 09/12/2017] [Revised: 10/18/2017] [Accepted: 10/25/2017] [Indexed: 11/26/2022] Open
Abstract
Laryngotracheoesophageal clefts (LTEC) are rare malformations which involve the upper respiratory and digestive tract. Surgical repair should be undertaken promptly to maintain a secure airway and prevent serious pulmonary aspiration. This paper reports the first case of LTEC type 3 with severe laryngotracheomalacia that was brought to Mofid children's hospital in late infancy with a poor health status. Delayed defect correction was our team strategy for the patient when she had achieved good weight gain. At the age of 22 months in collaboration with the pediatric surgical and otolaryngologist team, the repair of the laryngeal cleft was done with lateral open approach method. She was discharged with tracheostomy and gastrostomy. In the next six months follow up after the surgery tracheostomy decannulation and gastrostomy tube removal were done and the infant is now in regular follow-up.
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Affiliation(s)
- Ahmad Khaleghnejad
- Pediatric Surgery Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Sadr
- Department of Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Ahmad Tabatabaei
- Department of Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Farahbakhsh
- Department of Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Saeed Saadat Mansori
- Department of Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Blake KD, Hudson AS. Gastrointestinal and feeding difficulties in CHARGE syndrome: A review from head-to-toe. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:496-506. [PMID: 29082627 DOI: 10.1002/ajmg.c.31586] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 12/28/2022]
Abstract
CHARGE syndrome is an autosomal dominant genetic condition that is primarily diagnosed based on clinical features, with genetic testing available for confirmation. The CHARGE mnemonic stands for some of the common characteristics: coloboma, heart defects, atresia/stenosis of the choanae, retardation of growth/development, genitourinary anomalies, and ear abnormalities (CHARGE). However, many of the common clinical features are not captured by this mnemonic, including cranial nerve dysfunction, considered by some to be one of the major diagnostic criteria. Over 90% of individuals experience feeding and gastrointestinal dysfunction, which carries great morbidity and mortality. The aim of this review is to examine the nature of gastrointestinal (GI) symptoms and feeding difficulties in CHARGE syndrome, focusing on their underlying pathology, associated investigations, and available treatment options. We also provide information on available tools (for parents, clinicians, and researchers) that are important additions to the lifelong healthcare management of every individual with CHARGE syndrome. We review how cranial nerve dysfunction is one of the most important characteristics underlying the pervasive GI and feeding dysfunction, and discuss the need for future research on gut innervation and motility in this genetic disorder.
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Affiliation(s)
- Kim D Blake
- IWK Health Center, Halifax, Nova Scotia, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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A case of adult congenital laryngeal cleft asymptomatic until hypopharynx cancer treatment. Auris Nasus Larynx 2017; 45:640-643. [PMID: 28943051 DOI: 10.1016/j.anl.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/31/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022]
Abstract
Laryngeal cleft is an anomaly of failed posterior closure of the larynx. Most cases are diagnosed and need treatment early in life due to respiratory and swallowing problems. We report an unusual case of a 66-year-old man with an asymptomatic laryngeal cleft until treatment for hypopharyngeal cancer. During concurrent chemoradiotherapy (CCRT), despite reduced tumor volume, he presented severe dysphagia and dyspnea, followed by severe pneumonia twice. Because CCRT had to be discontinued, a pharyngolaryngectomy was performed for the cancer treatment. The resected specimen showed total removal of the tumor and a total longitudinal cleft of the cricoid cartilage, classified as a type III laryngeal cleft by the Benjamin and Inglis' classification. A review of computed tomography images indicated that the redundant mucosa from bilateral edges closed the separation of the posterior cricoid cartilage and narrowed the laryngeal airway during CCRT. Adult presentations of laryngeal cleft are quite rare with only ten reported cases in English literature; the present case is of the oldest patient. Undiagnosed cases with laryngeal cleft may exist asymptomatically or without severe symptoms. The awareness of this condition may increase its diagnosis as a cause of diseases such as aspiration and recurrent pneumonia even in adult patients.
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Vuncannon J, Albanna M, Evans AK. The adaptive use of a hand-crafted endotracheal-endobronchial tube for airway management in laryngo-tracheo-esophageal cleft type IV. Int J Pediatr Otorhinolaryngol 2017; 98:71-74. [PMID: 28583508 DOI: 10.1016/j.ijporl.2017.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/27/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Adele K Evans
- Wake Forest School of Medicine, Department of Otolaryngology, United States.
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Maughan E, Lesage F, Butler CR, Hynds RE, Hewitt R, Janes SM, Deprest JA, Coppi PD. Airway tissue engineering for congenital laryngotracheal disease. Semin Pediatr Surg 2016; 25:186-90. [PMID: 27301606 DOI: 10.1053/j.sempedsurg.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Regenerative medicine offers hope of a sustainable solution for severe airway disease by the creation of functional, immunocompatible organ replacements. When considering fetuses and newborns, there is a specific spectrum of airway pathologies that could benefit from cell therapy and tissue engineering applications. While hypoplastic lungs associated with congenital diaphragmatic hernia (CDH) could benefit from cellular based treatments aimed at ameliorating lung function, patients with upper airway obstruction could take advantage from a de novo tissue engineering approach. Moreover, the international acceptance of the EXIT procedure as a means of securing the precarious neonatal airway, together with the advent of fetal surgery as a method of heading off postnatal co-morbidities, offers the revolutionary possibility of extending the clinical indication for tissue-engineered airway transplantation to infants affected by diverse severe congenital laryngotracheal malformations. This article outlines the necessary basic components for regenerative medicine solutions in this potential clinical niche.
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Affiliation(s)
- Elizabeth Maughan
- Stem Cells and Regenerative Medicine Section, DBC, UCL Institute of Child Health, 30 Guilford St, London, UK; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Flore Lesage
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Development and Regeneration, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Colin R Butler
- Stem Cells and Regenerative Medicine Section, DBC, UCL Institute of Child Health, 30 Guilford St, London, UK; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Richard Hewitt
- Ear, Nose and Throat Department, Great Ormond Street Hospital, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jan A Deprest
- Stem Cells and Regenerative Medicine Section, DBC, UCL Institute of Child Health, 30 Guilford St, London, UK; Department of Development and Regeneration, Biomedical Sciences Group, University of Leuven, Leuven, Belgium; Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK; Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine Section, DBC, UCL Institute of Child Health, 30 Guilford St, London, UK; Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK.
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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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Rossi MS, Buhler KEB, Ventura GAB, Otoch JP, Limongi SCO. Laryngeal cleft type I in neonate: case report. Codas 2015; 26:421-4. [PMID: 25388077 DOI: 10.1590/2317-1782/20142013071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 08/04/2014] [Indexed: 01/19/2023] Open
Abstract
Laryngeal cleft (LC) is a congenital malformation that leads to the unusual communication between the esophagus and the laryngotracheal complex. It is a rare disease, mostly prevalent among male individuals. The goal of this study was to describe the evaluation and intervention by the speech language pathologist of a female newborn diagnosed with LC type I, admitted on the University Hospital of Universidade de São Paulo, in her second hospitalization due to small weight gain and pneumonia. She was submitted to a bedside clinical evaluation of the swallowing and the most important occurrence was frequent gagging. The videofluoroscopy swallowing study showed laryngotracheal aspiration level 8 for thin liquid and level 1 for thickened liquid, according to the Penetration-Aspiration Scale. The newborn was submitted to a microlaryngoscopy, in which the presence of LC type I was found. After the diagnosis, the speech language pathologist offered thickened liquid at 6% and, in 8 days, the newborn was discharged with exclusive oral diet without gagging. Eight outpatient consultations were carried out for 11 months, with emphasis on reintroduction of thin liquids. The treatment was discontinued and the patient was put on general diet for the age without modifications. Throughout follow-up, the patient remained asymptomatic and showed no respiratory complications.
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Affiliation(s)
| | | | | | - José Pinhata Otoch
- University Hospital, Universidade de São Paulo - USP, São Paulo, SP, Brazil
| | - Suelly Cecilia Olivan Limongi
- Department of Physical Therapy, Speech Language Pathology and Audiology and Occupational Therapy, School of Medicine, Universidade de São Paulo - USP, São Paulo, SP, Brazil
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The changing face of the paediatric microlaryngobronchoscopy (MLB): A two year prospective study. Int J Pediatr Otorhinolaryngol 2015; 79:1111-4. [PMID: 25980686 DOI: 10.1016/j.ijporl.2015.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/26/2015] [Accepted: 04/27/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Changes in the management and survival of paediatric patients with airway complaints combined with improving survival rates of premature babies have resulted in a different patient population for the paediatric airway surgeon than that previously described in the literature. OBJECTIVES To examine the presentation, diagnosis, clinical course and outcomes for patients undergoing microlaryngobronchoscopy (MLB). STUDY DESIGN 2 year prospective longitudinal study. STUDY POPULATION 210 microlaryngobronchoscopy examinations were performed on a total of 102 patients. Mean age at initial examination was 29.4 months with a male preponderance (68%). RESULTS 72 (71%) patients had other documented medical co-morbidities with 30 children having no previous medical history. Of the 102 patients the primary diagnoses were: Subglottic Stenosis (29.4%), Laryngomalacia (20.6%), Laryngeal Cleft (16.7%), Normal Anatomy (11.8%) and Vocal Cord pathology (5.9%). The average rate of diagnoses per patient for the whole cohort was 1.57. Of those patients with a diagnosis on examination, 40 had a solitary diagnosis whilst 50 patients (55.5%) were found to have multiple diagnoses, equating to 2.35 diagnoses per patient. Children with a history of prematurity accounted for 18.6% of our cohort with a 100% rate of laryngo-tracheal pathology on examination and an average number of diagnoses per child of 2.21. CONCLUSION Our cohort illustrates the varied population served by today's paediatric airway surgeon alongside common diagnoses and co-pathologies affecting our patients.
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Alexander NS, Liu JZ, Bhushan B, Holinger LD, Schroeder JW. Postoperative Observation of Children after Endoscopic Type 1 Posterior Laryngeal Cleft Repair. Otolaryngol Head Neck Surg 2014; 152:153-8. [DOI: 10.1177/0194599814556068] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objectives To report the perioperative management and surgical outcomes in a large series of pediatric patients with endoscopically repaired type 1 posterior laryngeal cleft (PLC). Study Design Case series with chart review. Setting Urban, tertiary care, free-standing pediatric hospital. Subjects and Methods Patients who underwent endoscopic carbon dioxide laser–assisted repair of type 1 posterior laryngeal clefts between January 2006 and December 2012. Medical records were reviewed. Results Fifty-four patients (34 male) underwent repair of type 1 PLC. Median age was 25.5 months (range, 2-120 months). Indications for repair included aspiration (n = 39; 72%), chronic bronchitis (n = 13; 24%), and stridor with feeds (n = 2; 4%). No children remained intubated postoperatively. Thirty-three patients (61%) stayed in overnight observation (“Obs PLC”) and 21 patients (39%) stayed in the pediatric intensive care unit (“PICU PLC”) postoperatively. Between Obs PLC and PICU PLC groups, there was no significant difference in age (mean 22 vs 30 months, respectively; P = .28). Comorbidities were similar between the groups. Symptoms improved in 41 of the 54 patients (76%). No postoperative complications were noted. Two patients required revision PLC repair. The cost of admitting a patient to a lower acuity location was estimated to be 60% less per day than cost of a PICU admission. Conclusions The endoscopic surgical repair of a type 1 PLC is successful and has a low morbidity and complication rate. Patients may be safely managed in an observation unit and without postoperative intubation. This approach achieved a marked cost reduction in postoperative care.
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Affiliation(s)
- Nathan S. Alexander
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Greenville Health System, Greenville, South Carolina, USA
| | - Judy Z. Liu
- Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bharat Bhushan
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren D. Holinger
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James W. Schroeder
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Ryan DP, Doody DP. Management of congenital tracheal anomalies and laryngotracheoesophageal clefts. Semin Pediatr Surg 2014; 23:257-60. [PMID: 25459009 DOI: 10.1053/j.sempedsurg.2014.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Congenital obstructions and anomalies of the pediatric airway are rare problems that may be associated with mild symptoms or critical stenoses that may be life threatening in the first few days of life. This review provides an overview of the embryologic development of the airway, different congenital anomalies associated with airway development, and surgical correction that may be associated with good long-term outcome.
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Affiliation(s)
- Daniel P Ryan
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, Massachusetts 02114.
| | - Daniel P Doody
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, Massachusetts 02114
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Riou F, Lecomte B, Travert B, Campagne D, Vanlieferinghen P. Malposition de sonde nasogastrique. Arch Pediatr 2014. [DOI: 10.1016/j.arcped.2014.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clinical and etiological heterogeneity in patients with tracheo-esophageal malformations and associated anomalies. Eur J Med Genet 2014; 57:440-52. [DOI: 10.1016/j.ejmg.2014.05.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/20/2014] [Indexed: 12/12/2022]
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Celli J. Genetics of gastrointestinal atresias. Eur J Med Genet 2014; 57:424-39. [DOI: 10.1016/j.ejmg.2014.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 06/21/2014] [Indexed: 01/04/2023]
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