Type IV Laryngeal Cleft: A Therapeutic Challenge
Keywords:Larynx, laryngeal cleft, surgery, repair
Type IV laryngeal cleft (LC) is a rare congenital malformation often associated with poorer prognosis compared to lower grades LC. The difficulty in managing LC lies in the ventilation prior to cleft repair, intraoperative anesthesia, technical difficulties to repair a longer cleft and higher rates of post-operative complications. We report a case of a premature neonate with type IV LC who underwent early gastrostomy at birth and survived with optimal medical management despite suffering bouts of pneumonia and life-threatening event. After a late cleft repair at 4-month old, she survived for 3 months post-operatively without complication of relapse fistula. Despite our cleft repair, she was unable to be weaned off from ventilator attributed to her poor neurological recovery and subsequently succumbed to death at 7 months. We would like to discuss the management challenges with regards to ventilation, approach of surgery as well as post-operative complication to improve the management of such complicated disease.
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