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.
- MeSH
- Child MeSH
- Esophagus diagnostic imaging surgery abnormalities MeSH
- Laryngoscopy MeSH
- Larynx * diagnostic imaging surgery abnormalities MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Trachea diagnostic imaging surgery abnormalities MeSH
- Congenital Abnormalities * MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Review MeSH
- Keywords
- dysphagia lusoria,
- MeSH
- Esophageal Atresia * diagnosis etiology MeSH
- Diverticulum, Esophageal MeSH
- Adult MeSH
- Esophagus * abnormalities physiopathology MeSH
- Esophageal Cyst MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Esophageal Fistula * etiology surgery complications MeSH
- Esophageal Stenosis MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Geographicals
- Czech Republic MeSH
Laryngotracheoezofageální rozštěp (LTER) je vzácná vrozená anomálie, při které nedojde k oddělení dýchacích a polykacích cest a ve střední čáře vzniká v různém rozsahu defekt v oblasti zadní stěny hrtanu, průdušnice a přední stěny hltanu a jícnu. Cílem chirurgického výkonu je rozdělení aerodigestivního kompartmentu do dvou fungujících traktů bez nutnosti závislosti na tracheostomii, s možností normální fonace a prevencí polykacích obtíží. V letech 1999 - 2009 jsme na Klinice ušní, nosní a krční 2. LF UK v Praze ve spolupráci s Klinikou dětské chirugie 2. LF UK FNM operovali 4 děti s LTER III. typu klasifikace dle Benjamina a Iglise. Ve většině případů jsme volili zevní přední krční přístup s interpozicí štěpu. V pooperačním období jsme zaznamenali komplikaci u jednoho pacienta, a to respirační insuficienci způsobenou tracheomalácií. Úspěšná léčba LTER závisí na včasné diagnóze, prevenci aspirace a gastroezofageálního refluxu, adekvátní výživě a včasném chirugickém výkonu.
Laryngotracheoesophageal cleft (LTEC) is a rare inborn anomaly, where the respiratory and swallowing pathways are not separated and in the middle line there is a defect of different extent in the area of posterior wall of larynx, trachea and anterior wall of pharynx and esophagus. The aim of surgical intervention is to divide aerodigestive compartments into two functional tracts without the need of dependence on tracheostomy, with the possibility of phonation and prevention of swallowing difficulties. In the period of 1999-2009 the authors operated on four children with LTER of the type III classification according to Benjamin and Iglis at the Ear, Nose and Neck Clinic, 2nd Medical Faculty, Charles University and Teaching Hospital Motol in collaboration with the Clinic of Child Surgery of the same location. In most cases the authors selected the external anterior cervical approach with interposition of the graft. In the postoperative period the authors encountered complications in one patient, specifically the respiratory insufficiency caused by tracheomalacia. A successful therapy of LTER depends on early diagnosis, prevention of aspiration and gastroesophageal reflux, adequate nutrition and a timely surgical intervention.
- Keywords
- přední krční přístup,
- MeSH
- Early Diagnosis MeSH
- Child MeSH
- Endoscopy MeSH
- Esophagus abnormalities surgery MeSH
- Infant MeSH
- Larynx abnormalities surgery MeSH
- Humans MeSH
- Abnormalities, Multiple epidemiology surgery mortality MeSH
- Otorhinolaryngologic Surgical Procedures methods MeSH
- Trachea abnormalities surgery MeSH
- Tracheoesophageal Fistula complications MeSH
- Tracheomalacia complications MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- MeSH
- Esophagus abnormalities MeSH
- Gastroscopy utilization MeSH
- Humans MeSH
- Esophageal Diseases diagnosis MeSH
- Heartburn etiology MeSH
- Gastric Mucosa abnormalities MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- General Surgery MeSH
- Child MeSH
- Esophagus abnormalities MeSH
- Infant MeSH
- Larynx abnormalities surgery MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Trachea abnormalities surgery MeSH
- Congenital Abnormalities diagnosis surgery MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Digestive System Abnormalities MeSH
- Digestive System Surgical Procedures MeSH
- Esophagus abnormalities surgery pathology MeSH
- Infant, Newborn MeSH
- Postoperative Complications MeSH
- Death etiology MeSH
- Digestive System pathology MeSH
- Congenital Abnormalities surgery complications MeSH
- Check Tag
- Infant, Newborn MeSH
