Surgical treatment of congenital laryngotracheo-oesophageal cleft.

Laryngotracheo-oesophageal cleft has been considered a rare congenital anomaly, diagnosed when there is respiratory distress on feeding, associated with multiple congenital disorders. A tracheo-oesophageal fistula should be excluded. Diagnosis, even in skillful endoscopic hands, is difficult. Different approaches to surgical repair have been advocated in literature. Most authors prefer the lateral approach. Only 7 patients have reportedly been treated via the anterior approach. The anterior approach offers the advantage of excellent and also easy exposure of the anomaly. The theoretical disadvantage of postoperative laryngeal instability is not substantiated by experimental work (Calcaterra, Ann Otol 83:810-813, 1974), nor by our own clinical experience in six juvenile patients who underwent laryngofissure for other reasons. A further advantage of the anterior approach is that the laryngeal nerves are not jeopardized as in the lateral approach. We have treated 4 patients. Two patients have been treated successfully via a lateral pharyngotomy approach; each of them has a left recurrent nerve palsy. The other two patients were treated via a laryngofissure, one of them successfully; in the other patient the cleft has been closed with success, but the larynx is still stenosed by excessive mucous membrane folds. Cicatricial subglottic stenosis, which may occur postoperatively, and the frequently coinciding tracheomalacia, have been successfully treated with prolonged nasotracheal intubation with siliconized silicone rubber tubes. Four patients were treated successfully. Three other patients have come to our attention. As is often the case, this disorder seems to occur more frequently than was previously thought.