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.