Challenges in the Diagnosis of Dysphagia in Infants: Two Case Reports of Rare Congenital Malformations

Introduction: Deglutition is a vital function for the newborn. Laryngeal cleft is a rare congenital abnormality in the posterior laryngotracheal wall. It occurs in approximately 1 in 10,000 to 20,000 births. Tracheoesophageal fistula is an abnormal connection between the esophagus and the trachea and affects 1 in 2,400 to 5,000 births. Diagnosis of both abnormalities comes after problems with feeding which includes coughing, cyanosis, failing to gain weight, and pulmonary infections. The diagnosis is established through the following endoscopic examination: microlaryngoscopy and bronchoscopy.

Objectives: The aim of this study is to describe two cases of congenital malformations leading to dysphagia in infants.

Resumed Report: Patient 1: A female patient (L. R. C.) presented with aspiration pneumonia in the 3rd day of life. She had normal suction and was fed by feeding tube. The modified barium swallow showed aspiration. The fiberoptic endoscopic evaluation of swallowing (FEES) was suspicion of laryngeal cleft. The hypothesis was confirmed by microlaryngoscopy palpation of the anatomic structures as laryngeal cleft type I and showed a benign evolution. Patient 2: MBMG, a female patient wheezing baby, coughing while feeding since 2 months born. She had two pulmonary infections, presented malnutrition, and was in use of feeding tube for 3 weeks. The FEES showed normal pharyngolaryngeal anatomy, normal swallow with pure, and penetration/coughing with liquids. The modified barium swallow was suggestive of tracheoesophageal fistula, and confirmed by the bronchoscopy. It was indicated surgical fistula closure.

Conclusion: The laryngeal cleft and tracheoesophageal fistula are rare conditions, and the clinical suspicion helps to make early and correct diagnoses.