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- Slide 1: Made possible by Cincinnati Children's | A 7-year-old with a repaired TEF/EA comes back with chronic cough and food impaction. | Dilations haven't helped. What do you suspect next?
- Slide 2: Made possible by Cincinnati Children's | THE FINDINGS | A second fistula... years later. | Referred for an esophageal diverticulum — airway evaluated too | A ledge at the esophageal anastomosis, with a dilated upper pouch | Bronchoscopy: granulation tissue along the back wall | Esophagraph: shows outpouching
- Slide 3: Made possible by Cincinnati Children's | Why these are hard to fix... | Second fistulas — and H-type fistulas — can be really difficult to manage endoscopically. | And open repair carries its own cost: the recurrent laryngeal nerve is at risk during recurrent TEF repair.
- Slide 4: Made possible by Cincinnati Children's | THE APPROACH | Go through the trachea. | A transtracheal approach gives better exposure — and keeps you off the nerve. | Step 1: Distal tracheotomy with the ET tube | Step 2: Bronchoscopy to localize the level of the fistula | Step 3: Make the tracheotomy over the fistula | Step 4: Work through it to divide the layers of the esophagus
- Slide 5: Made possible by Cincinnati Children's | WHY THE NERVE MATTERS | The injury you don't hear about. | Douglas von Allmen, MD | Member, Division of Otolaryngology - Head and Neck Surgery, Associate Professor, UC Department of Otolaryngology, Head and Neck Surgery, Cincinnati Children's | If it's a true paralysis, over time: | the muscle atrophies | long-term voice problems | potential aspiration issues
- Slide 6: Made possible by Cincinnati Children's | WHAT TO TAKEAWAY | Recurrent TEF can surface years after the original repair — chronic cough, food impaction, failed dilations. | A transtracheal approach improves exposure and helps protect the recurrent laryngeal nerve, along with the voice and swallowing that depend on it. | Full video — link in bio. | GC
Chronic Cough After TEF/EA Repair: What Do You Suspect Next?
Topic overview
Educational carousel addressing differential diagnosis and workup of persistent cough following tracheoesophageal fistula and esophageal atresia repair. Reviews common postoperative complications and diagnostic approach in this pediatric surgical population.
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