Bangalore: A team of doctors at Fortis Hospital in Bannerghatta road performed a complex procedure to treat a 10th-month-old baby here recently. The baby was suffering from a rare congenital defect known as Laryngeal cleft condition that may also involve the upper respiratory and digestive tract. The multi-specialty team of doctors was led by Dr Nischal R Pandya, Consultant, Paediatric Cardiovascular Thoracic Surgery along with Dr Susheen Dutt and Dr Athira R both of whom work as Consultants, Otorhinolaryngologists at the hospital.
A laryngotracheal cleft is a rare developmental disorder of the larynx. The reason behind this condition is idiopathic. The signs and symptoms may include inspiratory stridor which means making sound while breathing. This complex case involved the expertise from the Cardiovascular Thoracic team, otorhinolaryngology, anesthesia, and pediatric teams. Before the treatment, the child was unable to consume anything orally and was managed through nasogastric/orogastric tube (NGT) feedings for months and had repeated pneumonias and was severely malnourished. NGT feeding is a way of direct enteral feeding used for patients (infants, children, and adults) who are not able to take in enough calories by mouth or have swallowing difficulties. During this process, a tube is inserted through the nose/mouth, past the throat, and down into the stomach. Patients who are diagnosed with laryngeal clefts may have associated disorders related to swallowing and airway, leading to recurrent aspiration pneumonia, labored breathing, and failure to thrive.
Dr Nischal Pandya, Consultant Cardiovascular Thoracic Surgery, Fortis Hospital, Bannerghatta Road, said, “This is one of the rare procedures that is conducted at few centers in Bangalore. In this COVID era, airway work poses the highest risk but we had our processes in place to handle this little child even during these challenging times. We did an endoscopic laryngeal cleft repair (for a type 1 laryngeal cleft). There was surgical support from Dr Susheen and Dr Athira from the otorhinolaryngology team who made this surgery possible seamlessly. A diagnostic rigid bronchoscopy and esophageal-duodenoscopy was done to rule out other defects. We were able to conduct the procedure smoothly endoscopically. The child was further managed by pediatric and nutrition teams and he went home feeding mainly orally with night time top-up NG feeds. The child is now on complete oral feeds, NGT has been removed and is also gaining adequate weight.”
Laryngotracheoesophageal cleft is a rare developmental disorder of the upper airway which accounts for 0.3% to 0.5% of all congenital anomalies of the larynx. The reported incidence is variable from 1 in 10,000 to 1 in 20,000 live births, with more occurrence in males.
