laryngotracheoesophageal fissure
Introduction
Introduction to laryngotracheal esophageal fissure Laryngeal tracheal esophageal fissure (laryngotracheo-esophagealcleft, LTEC) is a rare congenital anomaly caused by the failure of the primordia on both sides of the sacral cartilage to merge and the esophageal tracheal septum to grow to the tail. The clinical symptoms are similar to esophageal tracheal fistula. Because saliva can't swallow, the child has a lot of sticky foam in the mouth and throat after birth. The saliva foam continuously overflows to the mouth, which is like a foamy foam. When feeding or feeding after birth, the child has cough and bruising. Often the incidence of other malformations is about 50%, the most common is esophageal atresia and esophageal fistula. basic knowledge The proportion of illness: 0.005% Susceptible people: good for infants and young children Mode of infection: non-infectious Complications: aspiration pneumonia
Cause
Laryngeal tracheal esophageal fissure
(1) Causes of the disease
Laryngeal tracheal esophageal fissure embryology is not clear, but according to esophageal embryo development, the pathogen is caused by abnormal development of the tracheal esophageal mediastinum at the anterior end of the fetus.
(two) pathogenesis
Pathological typing
According to the length of the crack extending downward, the laryngotracheal esophageal fissure can be divided into the following 4 types (Fig. 1): Type I: the fissure is down to the lower end of the annular cartilage through the scooped cartilage, accounting for 41% of all malformations, type II. : The downward extension of the crevice includes a portion of the membranous trachea, accounting for approximately 42%. Type III: the fissure reaches the tracheal bulge down to only 17%. Type IV: the cleft is crossed over the tracheal bulge to one side or both sides. Bronchial, this type is rare.
Because the trachea and the esophagus cannot be separated on the axis, the front and rear esophagus form a common channel.
2. Combined pathological malformations
Due to the upward development of the trachea and esophageal sag during embryonic development and affecting the fusion of annular cartilage, 20% to 37% of children with esophageal atresia with tracheal esophageal fistula, other gastrointestinal malformations: anal defects (21%), poor intestinal rotation (13%), meconium intestinal obstruction (8%), urinary malformation is 14% to 44%, including: hypospadias, inguinal hernia, cryptorchidism and renal hypoplasia, cardiovascular malformations accounted for 16% to 33 %, mainly ventricular septal defect, aortic coarctation and large vessel dislocation.
Prevention
Laryngeal tracheal esophageal fissure prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Laryngeal tracheal esophageal fissure complications Complications, aspiration pneumonia
More than 50% of children have aspiration pneumonia after feeding.
Symptom
Laryngeal tracheal esophageal fissure symptoms Common symptoms Difficulty breathing, coughing, hoarseness, sputum, saliva secretion
The clinical symptoms are similar to esophageal tracheal fistula. Because saliva can't swallow, the child has a lot of sticky foam in the mouth and throat after birth. The saliva foam continuously overflows to the mouth, which is like a foamy foam. When feeding or feeding after birth, the child has cough and bruising. Due to the lack of humerus and circumflex muscles, the vocal cords could not be closed, and the children were weak or silent when crying.
Examine
Laryngeal tracheal esophageal fissure
X-ray inspection
(1) Neck and chest radiograph: The image shows the inserted nasogastric tube moving forward; or the tracheal intubation as a respiratory supporter, the cannula is displaced backwards and slides into the esophagus.
(2) swallowing examination: contrast agent can be inserted into the tracheobronchial.
2. Laryngoscopy
When inhaling, because the appearance of the tracheal mucosa is close, endoscopy is often difficult to see. When this diagnosis is suspected, the endoscope can be pressed slightly to compress the posterior wall to open the fissure or to be confirmed by telescope endoscopy. The scope.
Diagnosis
Diagnosis and diagnosis of laryngotracheal esophageal fissure
Children with cough after sputum, difficulty breathing, more saliva, low crying, etc., should consider the possibility of laryngotracheal esophageal fissure, should be combined with laryngoscopy and X-ray examination, can be a clear diagnosis.
According to the clinical manifestations, it is easy to be confused with esophageal atresia with tracheal esophageal fistula or tracheal softening, and the best esophageal swallow angiography is identified.
