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Outcomes of surgical repair of Type III and IV laryngotracheoesophageal clefts with posterior cartilage grafting

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To describe the clinical outcomes of patients who underwent surgical repair through an anterior approach that involved interposition a posterior cartilage for Type III or Type IV laryngotracheoesophageal cleft (LTEC).

Methods

A chart view was performed on patients with Type III or Type IV LTEC between May 2017 and May 2022. Demographic features and surgical outcomes were collected and analyzed.

Results

Seven patients were finally included. Five patients were diagnosed with Type III LTEC and two patients were diagnosed with Type IV LTEC. All but one patients survived and thrived. Four patients were able to successfully extubate with acceptable voice, and two patients were tracheostomized. Five patients were deemed safe for all consistencies food and one was safe for thickened food. After a mean follow-up of 49 months (18–83 months), neither complications nor recurrences were observed.

Conclusion

An anterior laryngofissure approach to the cleft repair with a posterior cartilage grafting is an effective and safe treatment for Type III or IV LTEC, which enables closure of LTEC and reconstruction of cricoid plate in order to avoid tracheoesophageal fistula formation or subglottic stenosis postoperatively. Severe tracheomalacia and GERD are two main causes for surgical failure.

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Data availability

The data that support the findings of this study are available from the corresponding author, [Chao Chen], upon reasonable request.

References

  1. Seidl E, Kramer J, Hoffmann F, Schon C, Griese M, Kappler M, Lisec K, Hubertus J, von Schweinitz D, Di Dio D, Sittel C, Reiter K (2021) Comorbidity and long-term clinical outcome of laryngotracheal clefts Types III and IV: systematic analysis of new cases. Pediatr Pulmonol 56(1):138–144. https://doi.org/10.1002/ppul.25133

    Article  PubMed  Google Scholar 

  2. Li Y, Rui X, Li N (2020) Genetic factors in isolated and syndromic laryngeal cleft. Paediatr Respir Rev 33:24–27. https://doi.org/10.1016/j.prrv.2019.09.004

    Article  CAS  PubMed  Google Scholar 

  3. Benjamin B, Inglis A (1989) Minor congenital laryngeal clefts: diagnosis and classification. Ann Otol Rhinol Laryngol 98(6):417–420. https://doi.org/10.1177/000348948909800603

    Article  CAS  PubMed  Google Scholar 

  4. Yeung JC, Balakrishnan K, Cheng ATL, Daniel SJ, Garabedian EN, Hart CK, Inglis AF Jr, Leboulanger N, Liming BJ, Moreddu E, Nicollas R, Russell JD, Rutter MJ, Sidell DR, Spratley J, Soma M, Thierry B, Thompson DM, Triglia JM, Watters K, Wyatt M, Zalzal GH, Zur KB, Rahbar R (2017) International pediatric otolaryngology group: consensus guidelines on the diagnosis and management of Type I laryngeal clefts. Int J Pediatr Otorhinolaryngol 101:51–56. https://doi.org/10.1016/j.ijporl.2017.07.016

    Article  PubMed  Google Scholar 

  5. Kou YF, Redmann A, Smith MM, Hart CK, Rutter MJ, de Alarcon A (2021) Surgical treatment of Type III laryngotracheoesophageal clefts: techniques and outcomes. Laryngoscope. https://doi.org/10.1002/lary.29850

    Article  PubMed  Google Scholar 

  6. Mochizuki K, Shinkai M, Take H, Kitagawa N, Usui H, Asano F, Miyagi H, Fukumoto K (2014) Type IV laryngotracheoesophageal cleft repair by a new combination of lateral thoraco-cervical and laryngoscopic approaches. Pediatr Surg Int 30(9):941–944. https://doi.org/10.1007/s00383-014-3568-9

    Article  PubMed  Google Scholar 

  7. Kawahara I, Maeda K, Samejima Y, Kajihara K, Uemura K, Nomura K, Isono K, Morita K, Fukuzawa H, Nakao M, Yokoi A (2019) Repair of Type IV laryngotracheoesophageal cleft (LTEC) on ECMO. Pediatr Surg Int 35(5):565–568. https://doi.org/10.1007/s00383-019-04455-8

    Article  PubMed  Google Scholar 

  8. Ueha R, Goto T, Kaneoka A, Takano T, Sato T, Hirata Y, Nito T, Yamasoba T (2018) Management of laryngeal cleft in mechanically ventilated children with severe comorbidities. Auris Nasus Larynx 45(5):1121–1126. https://doi.org/10.1016/j.anl.2018.03.010

    Article  PubMed  Google Scholar 

  9. Leishman C, Monnier P, Jaquet Y (2014) Endoscopic repair of laryngotracheoesophageal clefts: experience in 17 cases. Int J Pediatr Otorhinolaryngol 78(2):227–231. https://doi.org/10.1016/j.ijporl.2013.10.068

    Article  PubMed  Google Scholar 

  10. Nicollas R, Sudre-Levillain I, Roman S, Triglia JM (2006) Surgical repair of laryngotracheoesophageal clefts by tracheoesophagoplasty with two overlapping flaps. Ann Oto Rhinol Laryn 115(5):346–349. https://doi.org/10.1177/000348940611500505

    Article  Google Scholar 

  11. Geller K, Kim Y, Koempel J, Anderson KD (2010) Surgical management of Type III and IV laryngotracheoesophageal clefts: the three-layered approach. Int J Pediatr Otorhinolaryngol 74(6):652–657. https://doi.org/10.1016/j.ijporl.2010.03.013

    Article  PubMed  Google Scholar 

  12. Propst EJ (2016) Repair of short Type IV laryngotracheoesophageal cleft using long, tapered, engaging graft without need for tracheotomy. Laryngoscope 126(4):1006–1008. https://doi.org/10.1002/lary.25472

    Article  PubMed  Google Scholar 

  13. Zhu Qirong ZW, Xiao Xianmin Lu, Yiqun QZ, Qinghe X, Haidong K, Liling Q, Xiaohua S, Yin Y (2020) A retrosoective study on patients with laryngotracheoesophageal cleft. Res Ethics Board Approval 168:1

    Google Scholar 

  14. McClay JE, Brewer J, Johnson R (2011) Sutureless vs sutured posterior costal cartilage grafting in laryngotracheal reconstruction in children. Arch Otolaryngol Head Neck Surg 137(12):1276–1279. https://doi.org/10.1001/archoto.2011.209

    Article  PubMed  Google Scholar 

  15. de Trey LA, Lambercy K, Monnier P, Sandu K (2016) Management of severe congenital laryngeal webs - a 12 year review. Int J Pediatr Otorhinolaryngol 86:82–86. https://doi.org/10.1016/j.ijporl.2016.04.006

    Article  PubMed  Google Scholar 

  16. Green Corkins K, Teague EE (2017) Pediatric nutrition assessment. Nutr Clin Pract 32(1):40–51. https://doi.org/10.1177/0884533616679639

    Article  PubMed  Google Scholar 

  17. Blumberg JB, Stevenson JK, Lemire RJ, Boyden EA (1965) Laryngotracheoesophageal cleft, the embryologic implications: review of the literature. Surgery 57:559–566

    CAS  PubMed  Google Scholar 

  18. Hernandez G, Beauchamp-Perez FD, Gonzalez-Aquino C (2018) Laryngeal cleft Type IV: One pathology, two different presentations. Int J Pediatr Otorhinolaryngol 109:154–157. https://doi.org/10.1016/j.ijporl.2018.04.007

    Article  PubMed  Google Scholar 

  19. Sonmez K, Karabulut R, Turkyilmaz Z, Turkyilmaz C, Isik B, Eryilmaz S, Seref K, Ozcan E, Hosgoren GM, Basaklar AC (2017) Our experience in two cases of Type IV laryngotracheoesophageal cleft (LTEC) with a diagnosis of antenatal esophageal atresia. Pan Afr Med J 26:55. https://doi.org/10.11604/pamj.2017.26.55.10647

    Article  PubMed  PubMed Central  Google Scholar 

  20. Propst EJ, Ida JB, Rutter MJ (2013) Repair of long Type IV posterior laryngeal cleft through a cervical approach using cricotracheal separation. Laryngoscope 123(3):801–804. https://doi.org/10.1002/lary.23660

    Article  PubMed  Google Scholar 

  21. MyerCotton CMRT, Holmes DK, Jackson RK (1990) Laryngeal and laryngotracheoesophageal clefts: role of early surgical repair. Ann Otol Rhinol Laryngol 99(2 Pt 1):98–104. https://doi.org/10.1177/000348949009900203

    Article  Google Scholar 

  22. Arslankoylu AE, Unal E, Kuyucu N, Ismi O (2016) Anterior laryngofissure approach in Type III laryngotracheal cleft: a case report. Acta Otorhinolaryngol Ital 36(5):431–434. https://doi.org/10.14639/0392-100X-636

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Mathur NN, Peek GJ, Bailey CM, Elliott MJ (2006) Strategies for managing Type IV laryngotracheoesophageal clefts at Great Ormond street Hospital for Children. Int J Pediatr Otorhi 70(11):1901–1910. https://doi.org/10.1016/j.ijporl.2006.06.017

    Article  Google Scholar 

  24. Sandu K, Monnier P (2006) Endoscopic laryngotracheal cleft repair without tracheotomy or intubation. Laryngoscope 116(4):630–634. https://doi.org/10.1097/01.mlg.0000200794.78614.87

    Article  PubMed  Google Scholar 

  25. Propst EJ (2017) Revision repair of Type IV laryngotracheoesophageal cleft using multiple long tapered engaging grafts. Int J Pediatr Otorhinolaryngol 103:80–82. https://doi.org/10.1016/j.ijporl.2017.10.014

    Article  PubMed  Google Scholar 

  26. Jauregui EJ, Propst EJ, Johnson K (2020) Current management of Type III and IV laryngotracheoesophageal clefts: the case for a revised cleft classification. Curr Opin Otolaryngol Head Neck Surg 28(6):435–442. https://doi.org/10.1097/MOO.0000000000000669

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kawaguchi AL, Donahoe PK, Ryan DP (2005) Management and long-term follow-up of patients with Types III and IV laryngotracheoesophageal clefts. J Pediatr Surg 40 (1):158–164; discussion 164–155. https://doi.org/10.1016/j.jpedsurg.2004.09.041

  28. Serio P, Leone R, Fainardi V, Baggi R, Murzi B, Noccioli B, Arcieri L, Mirabile L (2014) The role of endoscopy in the treatment of IV Type laryngotracheal cleft complications after surgical repair. Int J Pediatr Otorhinolaryngol 78(2):377–380. https://doi.org/10.1016/j.ijporl.2013.11.022

    Article  CAS  PubMed  Google Scholar 

  29. Wahidi MM, Ernst A (2003) The montgomery T-tube tracheal stent. Clin Chest Med 24(3):437–443. https://doi.org/10.1016/s0272-5231(03)00042-x

    Article  PubMed  Google Scholar 

  30. Peng L, Wei W (2021) Tube-in-tube airway management in a patient with montgomery T-tube in situ -a case report. Korean J Anesthesiol 74(2):165–168. https://doi.org/10.4097/kja.20171

    Article  PubMed  Google Scholar 

  31. Wootten CT, Rutter MJ, Dickson JM, Samuels PJ (2009) Anesthetic management of patients with tracheal T-tubes. Paediatr Anaesth 19(4):349–357. https://doi.org/10.1111/j.1460-9592.2009.02957.x

    Article  PubMed  Google Scholar 

  32. Evans KL, Courteney-Harris R, Bailey CM, Evans JN, Parsons DS (1995) Management of posterior laryngeal and laryngotracheoesophageal clefts. Arch Otolaryngol Head Neck Surg 121(12):1380–1385. https://doi.org/10.1001/archotol.1995.01890120038007

    Article  CAS  PubMed  Google Scholar 

  33. Owusu JA, Sidman JD, Anderson GF (2011) Type IV laryngotracheoesophageal cleft: report of long-term survivor successfully decannulated. Int J Pediatr Otorhinolaryngol 75(9):1207–1209. https://doi.org/10.1016/j.ijporl.2011.06.010

    Article  PubMed  Google Scholar 

  34. Martha VV, Vontela S, Calder AN, Martha RR, Sataloff RT (2021) Laryngeal cleft: a literature review. Am J Otolaryngol 42(6):103072. https://doi.org/10.1016/j.amjoto.2021.103072

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Children’s Hospital of Fudan University, Shanghai, 201102, China

    Letian Tan, Qi Li & Chao Chen

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  1. Letian Tan
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  2. Qi Li
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Correspondence to Chao Chen.

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Tan, L., Li, Q. & Chen, C. Outcomes of surgical repair of Type III and IV laryngotracheoesophageal clefts with posterior cartilage grafting. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08701-1

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