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Related Experiment Videos

Cervical tracheoesophageal fistula.

R P Green, H F Biller, A Sicular

    The Laryngoscope
    |March 1, 1983
    PubMed
    Summary

    This study presents four unique cervical tracheoesophageal fistula (TEF) cases, detailing diagnosis and treatment. Surgical approaches vary, with cervical access suitable for TEFs above T2, offering insights into rare TEF management.

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    Area of Science:

    • Otolaryngology
    • Thoracic Surgery
    • Surgical Oncology

    Background:

    • Cervical tracheoesophageal fistula (TEF) is rare, with congenital forms often presenting in the neck.
    • Malignant TEFs typically arise from esophageal, lung, or thyroid cancers, but metastatic breast carcinoma is a newly reported cause.
    • Acquired non-malignant cervical TEFs can result from trauma, intubation, or inflammatory conditions.

    Observation:

    • Four unusual cervical TEF cases are detailed: a unique adult congenital "H" type TEF with prior thoracic TEF repair, a TEF secondary to metastatic breast carcinoma, a stomal recurrence TEF, and an acquired non-malignant TEF post-laryngectomy.
    • Metastatic breast carcinoma causing TEF is reported for the first time.
    • An adult with a cervical "H" type TEF, who had a prior thoracic TEF repair in infancy, represents a unique presentation.

    Findings:

    • Surgical management for cervical TEF above T2 may involve a cervical approach.
    • Preferred surgical technique for congenital TEF includes two-layer closure of the trachea and esophagus with strap muscle interposition.
    • Palliative options for malignant TEF include esophageal intubation, colon bypass, or gastric pull-up with esophageal exclusion. One-stage resection and reconstruction with a pectoralis major myocutaneous flap and gastric pull-up is used for stomal recurrence.
    • Prompt surgical closure is the treatment of choice for acquired non-malignant cervical TEF, though some cases may require medical therapy.

    Implications:

    • This report expands the understanding of rare cervical TEF etiologies, including metastatic breast carcinoma.
    • The findings highlight the importance of considering diverse causes for cervical TEF and tailoring surgical or palliative strategies accordingly.
    • Effective management strategies for both congenital and acquired cervical TEFs, including malignant and non-malignant types, are discussed, emphasizing surgical intervention where appropriate.

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