Consensus recommendations on the evaluation and treatment of congenital laryngeal clefts / 临床耳鼻咽喉头颈外科杂志

Congenital laryngeal cleft is a rare airway malformation, mainly manifested as choking, feeding difficulties, which affects the growth and development of children. Patients with a severe laryngeal cleft may have recurrent aspiration, leading to cyanotic spells, or even death. Advances in development of endoscopic techniques have made early diagnosis possible. Depending on the degree of cleft, management may involve a variety of approaches ranging from medical management alone to open repair. Therefore, it is important for pediatric ENT doctors to diagnose and evaluate in clinical practice. This consensus statement, developed by the Pediatric otorhinolaryngology Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, provides comprehensive recommendations and standardized guidance on diagnosis and management of laryngeal cleft, based on symptomatology, physical examinations, and laboratory tests.

Anesthetic Management of a Patient with Type III Laryngotracheoesophageal Cleft: A case report / 대한마취과학회지

Congenital laryngotracheoesophageal cleft is a rare anomaly due to failure of fusion of the esophagus and the larynx, which presents a challenge to the anesthesiologists because of the potential problems of establishing and maintaining an airway. We could know that tracheal intubation does not guarantee a safe airway as there is the danger that the tube may slip through the cleft into the esophagus resulting in inability to maintain ventilation. We report a case of a one-month-old baby with a type III laryngotracheoesophageal cleft and review the literature on different ways of managing the airway.

A case of laryngeal cleft

Laryngotracheoesophageal cleft is a rare congenital anomaly characterized by a midline defect of variable length between the posterior larynx and trachea and the anterior wall of the esophagus which was first reported by Richter in 1792. The male, birth weight 2780 gm, was born our hospital, After birth the infant breathed spontaneously, cried immediately but weak and did well initially but after minutes appeared moderate amount of mucus in the mouth, and sterile water was given but immediately vomited with chocking, cough and cyanosis. A nasogastric tube was inserted through the esophagus without resistance and kinking. Esophagogram was showed spillage of contrast media simultaneously into trachea and esophagus. In direct laryngoscopy, there appeared to be small laryngeal cleft posteriorly, to the level of vocal cord. But bronchoscopy could not be performed due to narrow tracheal orifice. So we confirmed the laryngeal cleft by means of CT and MRI of neck. CT and MRI scan of neck demonstrated a cleft in interarytenoid lesion and connection between esophagus and laryngeal lumen.