2011 Volume 32 Issue 1 Pages 7-10
We report a case of Floyd's type II tracheal agenesis. A male infant weighing 3146 g was born at 39 weeks of gestation. He did not cry but instead showed cyanosis and severe respiratory distress after birth. Bag-mask ventilation was briefly effective, but tracheal intubation was never successful. His trachea was not detected by neck palpation. An attempt to examine his trachea by fiberoptic laryngoscopy failed because of complete closure of the airway just under the glottis. His respiratory condition improved slightly after esophageal intubation. He underwent esophageal banding and a gastrostomy on day 0. A bronchoesophageal fistula 1.5 mm in diameter was found at the middle esophagus by endoscopy after the surgery. A CT scan revealed that his trachea was absent but both main bronchi appeared to be normally bifurcated from the carina just below the bronchoesophageal fistula. The clinical diagnosis was tracheal agenesis (Floyd's type II). The respiratory distress was progressive, and he died on the 38th day after birth. Tracheotomy is one of the major initial treatment options for respiratory failure caused by congenital upper airway blockage such as laryngeal atresia or laryngo-tracheo-esophageal cleft. However, if the trachea is absent, such as in this case, the only method to support respiration is esophageal intubation. Pediatric otolaryngologists who perform emergency tracheotomies on newborns should therefore be familiar with this disease.
