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Published on: March 18, 2020
Repair of long type IV posterior laryngeal cleft through a cervical approach using cricotracheal separation
Evan J Propst1, Jonathan B Ida, Michael J Rutter
1Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Insights
This study presents a novel transcervical repair for long tracheoesophageal fistula in infants with CHARGE syndrome. The minimally invasive technique avoids major surgery, offering improved outcomes for complex airway defects.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Thoracic Surgery
Background:
- CHARGE syndrome is a complex genetic disorder often associated with life-threatening congenital anomalies.
- Long tracheoesophageal fistula (TEF) extending to the carina presents significant surgical challenges in infants.
- Traditional repair methods often require extensive surgical approaches like sternotomy and cardiopulmonary bypass.
Abstract:
A female infant with CHARGE syndrome and a long type IV cleft extending to within 5 mm of the carina underwent transcervical repair at 5 weeks of age. The trachea was transected from the cricoid cartilage and was peeled off the esophagus. The front of the esophagus and the back of the trachea were repaired while still ventilating the patient. The trachea was reconnected to the cricoid cartilage. This technique obviated the need for a sternal split, thoracotomy, cardiopulmonary bypass, or extracorporeal membrane oxygenation. It improved visibility, access, airway stability, and coverage of the anastomosis with periosteum permitting a three-layer closure.
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