Complete laryngotracheoesophageal cleft: complicated management issues.

OBJECTIVES/HYPOTHESIS: Laryngotracheoesophageal clefts are rare developmental anomalies of the upper aerodigestive tract. They range in severity from being virtually asymptomatic throughout life (type I) to being incompatible with life (type IV). The timing of diagnosis is crucial to the successful treatment of severe clefts. Treatment is complicated and requires a multi-team approach. The case report discusses the elements involved in diagnosing and treating this severe airway anomaly.

STUDY DESIGN

Case report.

METHODS

Review of a case at a tertiary care center.

RESULTS

A case of a complete laryngotracheoesophageal cleft with left-side pulmonary agenesis in a newborn is reported. Rigid bronchoscopy revealed a common tracheoesophageal lumen from the larynx to the stomach with a single bronchus supplying the right-side lung. Management of this patient included establishment and maintenance of a tenuous airway, maintenance of nutrition, and anesthetic and surgical planning for upper aerodigestive tract reconstruction.

CONCLUSIONS

Although severe laryngotracheoesophageal clefts are rare, they require prompt, team-oriented management for the best outcome possible. The diagnosis, sustenance, and treatment options of these patients depend on varied and complicated factors, which are discussed.