Repair of short type IV laryngotracheoesophageal cleft using long, tapered, engaging graft without need for tracheotomy.

UNLABELLED An infant with a type IV laryngotracheoesophageal cleft underwent transcervical repair using a long tapered cartilage graft. A laryngofissure was carried down to the innominate artery to expose the cleft that extended 5 mm inferior to the vessel. The edges of the cleft were excised, the trachealis was separated from the esophagus that was reapproximated, and clavicular periosteum was placed. A long posterior costal cartilage graft that tapered inferiorly in anteroposterior dimension and engaged behind the cricoid plate was inserted. This added rigidity to the repair and obviated the need for a tracheotomy while providing a four-layer closure. LEVEL OF EVIDENCE NA.