Tracheoesophageal Cleft

Laryngotracheoesophageal cleft (LTEC) is a congenital midline anomaly, which defines when there is a defect of the posterior part of larynx and trachea and the anterior wall of the esophagus. It is rare but attributed with considerable mortalities and morbidities (1, 6). There is no specific pattern of inheritance and most reported cases had a sporadic pattern, however, some reports from familial occurrence with autosomal dominant pattern also have been reported in the literature (1). Respiratory bud develops from diverticulum on foregut, at the 4th week of gestation. Tracheobronchial groove starts to exist on both sides and reach together in the midline and form the tracheoesophageal septum by the 5th week of gestation. Failure in development of tracheoesophageal septum results in the occurrence of LTEC. In which phase the fusion process interruption occurs, determine the length of cleft (3, 7). Males are affected more than females (1, 8), but in the index case, we report a female in contrast to most of the earlier reported cases. Contributing conditions such as prematurity and polyhydramnios have been reported in the majority of previous cases (8), but
It was published in 1989 and according to it, LTECs are categorized into four types (4). Type I defined as a defect of inter-arytenoid to the level of the true vocal folds, type II is when the defect affects the posterior cricoid cartilage, type III is the extension of the defect entirely through the posterior cricoid cartilage and possible involvement of the cervical trachea, and type IV defined as an extension into the intrathoracic trachea(4). Among these types, particularly types 3 and 4 are a real challenge in diagnosis and clinical management (5) and these patients need multidisciplinary approach from pediatric surgeons, otolaryngologists, pediatric pulmonologists, and