Two rare cases of oesophageal atresia associated with a posterior laryngeal cleft were treated successfully: a so-called "O" interarytenoid cleft recognised secondarily to the type II atresia, not treated surgically; a so-called II cricoid cleft recognised before the treatment of type I atresia was closed in a first stage by an anterior transl-laryngeal approach. A bibliographical review is followed by a discussion of the diagnosis aspects and therapeutic possibilities of laryngeal cleft, the approach, the timing of surgery on the basis of its type and the type of oesophageal atresia.

Abnormalities, Multiple↗

PubMedDate not supplied

[Respiratory and swallowing difficulties after oesophageal atresia (author's transl)].

The main reason for these problems is a tracheo-oesophageal fistula, either recurrence of the T.O. fistula, either persistance of a fistula which has been neglected during surgery. It has been observed in 7 infants from 19 operated atresias with such problems. These functionnal troubles may be produced by different other anomalies: oesophageal stenosis and or dyskinesia often observed, gastro-oesophageal reflux, associated anomalies of the larynx or trachea; laryngeal paralysis, tracheomalacia, tracheal epithelium metaplasia, tracheal compression by abnormal vessel, neurological dysmaturity, loss of swallowing reflex after a long postoperative course. Radiography and endoscopy are fundamental and complementary investigations. Endoscopy, under general anesthesia, must be minute (with optics), explore oesophageal and laryngo-tracheo-bronchic tract, and use several tests to demonstrate permeability of the fistula when it has been located. A special technique is presented. Several points must be outlined: 1--classical symptoms of persistant fistula are not reliable in authors' experience; any recurrent respiratory and swallowing problem requires investigations; 2--endoscopy and radiographic study have to be repeated sometimes to prove fistula; 3--responsability of some anomalies must be always discussed, because of their possible association with a fistula; several fistulas may also exist.

Deglutition Disorders↗