Does the presence of a tracheoesophageal fistula predict the outcome of laryngeal cleft repair?

Objective: To determine if the presence of a tracheoesophageal fistula (TEF ) alters outcome following laryngeal cleft repair. Design: A retrospective review of patients diagnosed and treated for laryng eal clefts, with a minimum follow-up period of 1 year. Setting: An academic tertiary care children's hospital. Patients: Twenty-five pediatric patients diagnosed and surgically treated f or laryngeal cleft. Main Outcome Measures: Each chart was reviewed to determine if patients wit h a laryngeal cleft had been diagnosed with TEF and had undergone a surgica l TEF repair procedure. The success of the surgery was evaluated based on t he resolution of symptoms and the endoscopic evaluation of the repair site. Results: Twenty-five patients were reviewed for study purposes. Fourteen ha d a history of TET; repair and II, no history of TEF. All 25 patients under went surgical repair of the laryngeal cleft. Twelve of the 14 patients with a history of TEF repair experienced a breakdown of the laryngeal cleft rep air. Only 1 of the 11 patients with no history of TEF experienced such a br eakdown. In 8 of 9 patients with a laryngotracheoesophageal type I cleft, s urgical repair was not successful. Conclusions: In our series, patients with laryngeal clefts who also had a h istory of TEF had a much higher incidence of breakdown of cleft repair comp ared with patients with no history of TEF. This finding is not conclusive a nd requires further investigation. The failure of cleft repair correlated w ith the severity of the cleft. The importance of these associations may lea d to enhanced surgical planning and realistic preoperative family expectati ons.