Laryngotracheal cleft (LTC) is a rare congenital defect in which there is a gap between the upper airway passage (larynx and possibly trachea) and the food passage (esophagus). In normal development, the airway and esophagus come from a common tube called the foregut. Early in embryologic development, the airway separates from the esophagus with the formation of the tracheoesophageal septum.
LTC is thought to occur in children whose septum does not completely develop, resulting in variable degrees of communication between the airway and esophagus. Because of the defect the child can inadvertently inhale food or even secretions into the lungs. Children with LTC often also have other midline defects such as tracheoesophageal fistula, cleft lip/palate and heart defects.
Treatment for mild cases
These include type 1 cases where the child is not having respiratory distress. These patients may initially be managed with close observation, thickened feeds and reflux management. In cases where these strategies are not effective, a temporary feeding tube and endoscopic repair is considered.
Some milder forms of laryngotracheal clefts can be repaired using an endoscopic laryngotracheal cleft repair.
In this procedure either a CO2 laser or a microlaryngeal scissors instrument is used to freshen the edges in the undeveloped lining of the cleft. Resorbable sutures (sutures that biodegrade in the body) are then used to close the cleft.
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