Tracheoesophageal

Tracheoesophageal refers to the trachea and esophagus, and is used when describing structures or conditions that involve both organs. The most clinically important use is in reference to tracheoesophageal fistula (TEF) and to esophageal atresia with TEF, congenital anomalies in which a connection between the airway and the digestive tract develops. The term also appears in anatomy, as in the tracheoesophageal groove, an anatomical space marking the left-side border between the two tubes.

Anatomy and embryology: The trachea and esophagus originate from the foregut and are normally separated by a partition formed by the tracheoesophageal ridges. In TEF, incomplete separation leads to a fistulous connection. Congenital esophageal atresia with TEF occurs in about 1 in 2,500 to 4,000 live births and is frequently associated with other anomalies (VACTERL sequence).

Clinical features: In newborns, TEF with esophageal atresia presents with excessive drooling, choking or coughing with feeds, cyanosis, and respiratory distress shortly after birth. Polyhydramnios may be detected prenatally due to impaired fetal swallowing.

Diagnosis: Prenatal ultrasound may show polyhydramnios; postnatal radiographs can reveal a gasless abdomen or gas in the proximal GI tract; contrast esophagography or CT can delineate the fistula and anatomy.

Treatment and prognosis: Management centers on airway protection and preventing aspiration, followed by surgical repair to close the fistula and restore esophageal continuity. Outcomes improve with isolated anomalies; survival exceeds typical rates in developed centers but is lower with additional congenital problems.

Acquired TEF: Tracheoesophageal fistulas can be acquired later in life from malignancy, trauma, prolonged intubation, or inflammatory disease; treatment targets the underlying cause and airway stabilization.