TA is a rare congenital lethal anomaly and has been reported for the first time by Payne (4). Antenatal diagnosis is difficult and severe respiratory distress with no air entry, no audible cry, and difficult intubation are diagnostic findings in the postnatal period. Additionally, in the presence of polyhydramnios anamnesis and other anomalies associated with TOF, possible tracheal pathologies should be considered. This malformation of the trachea is generally incompatible with life due to the fact that tracheostomies cannot be performed to provide ventilation. In the literature, insertion of a tracheostomy tube through a proximal oesophagostomy into the oesophagobronchial communication has been described (5, 6).
Floyd's classification is the most commonly used system for classification of tracheal agenesis (3). This classification was broken into three subtypes (7); Type I is characterized by absence of proximal trachea and distal trachea is connected to the oesophagus by a fistula, Type II, has a complete absence of trachea and localization of bronchial bifurcation is normal, and Type III, two main bronchi arise independently from the oesophagus.
In infants where TA was associated with oesophageal communication with the trachea or main bronchi, oesophageal intubation can be lifesaving (8). However, most of these infants die during the first hours or days of their life, due to other congenital malformation, difficulties in diagnosis, and failure to manage airway. In addition, prematurity and respiratory distress syndrome can be the cause of mortality and morbidity by itself.
Various surgical approaches have been attempted, although a definitive treatment strategy has not been established. However, in recent years, a few case reports with TA that were treated with oesophageal reconstruction and did not require mechanical ventilation have been reported (1, 9-11). These cases in the literature, reveal that good long-term improvement is possible after successful airway/alimentary tract reconstruction.
As we learn more about the embryological development of the trachea, new surgical reconstruction techniques will develop in the future for survival of these babies.
3.1. Conclusion
In early diagnosis and proper airway stabilization by esophageal intubation, short-term respiratory support may be allowed; this approach can prevent acute anoxia and hypoxia in newborns.
Therefore, we consider that early clinical diagnosis and oesophageal intubation technique should be remembered by the anesthesiologists for the possibility of advanced life in patients with tracheal agenesis.
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