RESULTS
Over the 20-year period, a total of 8,125 FE procedures of AET were
performed in 4,227 patients. Among them, 12 infants (7 male, 58.3%) had
a diagnosis of LC, with an incidence of 0.28% in our FE patients. Of
these infants, 8 was type I, 3 was type II, and 1 was type III (Table
1). These LC diagnosis were all made in their first FE-SPI examination.
The type III LC was further confirmed with RE. At the time of FE
diagnosis, their mean age was 5.0 ± 4.9 (ranged from 6 hours to 18
months) months old, the mean body weight was 4.7 ± 2.3 (ranged from 2.7
to 10.6) kg.
Nine (10/12, 83.3%) infants were referred from other hospitals,
included 7 infants from 6 tertiary children’s hospitals and 2 infants
from neighboring countries, for management of their refractory
respiratory problems. Among them, before admitted to our hospital, 7
infant’s airway were already examined with 11 FE and 5 computed
tomography studies, no LC was found. Nine infants had failure to thrive.
Four infants had tracheal intubation and 3 had prolonged mechanical
ventilation support due to pneumonia, respectively. All 12 FE-SPI
procedures were performed within three hours of admission.
Under FE-SPI inspection, the whole PLS could be gradually lifted and
clearly visualized. In particular supraglottis, bilateral arytenoids
with redundant tissue and cleft itself could be pneumatically separated
and precisely identify its type, included depths of the cleft. All the
LC lesions of these 12 infants were successfully recognized at their
first FE-SPI examination of the larynx before checking the tracheal or
esophageal lumens. The time for a complete diagnosis of LC ranged from
3.0 to 5.5 minutes, with a mean of 4.2 ± 0.9 minutes.
Ten (90.9%) infants coexisted
with airway abnormalities including 9 infants (9/12, 75.0%) with
laryngomalacia and 3 infants (3/12, 25.0%) with tracheal or bronchial
malacia. Four infants (4/12, 25.0%) had coexisting gastroesophageal
reflux.
All infants tolerated the FE-SPI procedure. No associated complications
such as oxygen desaturation (< 90%), bradycardia (heart beat
<100/min), ear drum perforation, subcutaneous air leak,
pneumothorax or AET bleeding were noted.