Laryngotracheal Separation for Benign Acquired Tracheoesophageal Fistula Developing During Long Term Tracheostomy Management: A Case Report

Abstract

A 14-year-old girl was diagnosed as having a tracheoesophageal fistula during long-term tracheostomy management for spinal muscular atrophy type 1, due to recurrent aspiration pneumonia and the difficulty in changing the cannula, and she was transferred to our hospital. Flexible/rigid bronchoscopy and upper gastrointestinal endoscopy revealed a tracheoesophageal fistula extending 4 cm caudally from the tracheostomy site. A cervical approach was used to resect the necrotic tracheal wall, repair the esophageal fistula, and perform a laryngotracheal separation with the infrahyoid muscles interposed to prevent direct contact between the repaired esophagus and the trachea. The postoperative course was uneventful, and the patient was transferred back to the previous hospital on the 16th postoperative day. Benign acquired tracheoesophageal fistula is a rare condition, primarily caused by chronic mechanical compression from tubes or cuffs. It is important to thoroughly evaluate the location, size, and condition of the trachea and esophagus prior to surgery and to consider treatment options tailored to the individual case. This case suggests that laryngotracheal separation surgery may be an effective treatment option.