Abnormal tracheal innervation in patients with esophageal atresia and tracheoesophageal fistula: Study of the intrinsic tracheal nerve plexuses by a microdissection technique

The automatic nervous plexus of the trachea of patients with esophageal atresia and tracheoesophageal fistula (EA-TEF) was examined by a microdissection method. Of 28 autopsied patients with EA-TEF, four patients who had not had esophageal anastomosis were selected, to exclude any changes secondary to anastomosis. The plexus of the pars membranacea of the trachea was hypoplastic in all four patients, and severely so in one. An extra plexus, similar to the myenteric plexus of the esophagus, was present in three of the patients, and an abnormal muscle bundle was seen in the fibroelastic tissue dorsal to the pars membranacea of the trachea in two patients. These findings are suggestive of abnormal separation of the trachea from the esophagus. An abnormal extrachondral plexus was also observed in two patients. These congenital abnormalities of the intrinsic tracheal nervous plexus may be related to tracheal dysfunction and respiratory symptoms in patients who survive EA-TEF.