Original Study

Endoscopic repair of laryngeal cleft type I and type II: When and why?

  1. Reza Rahbar DMD, MD1,*,
  2. Judy L. Chen MD1,
  3. Rachel L. Rosen MD3,
  4. Kristen C. Lowry BA1,
  5. Dawn M. Simon MD6,
  6. Jennifer A. Perez MS, CCC-SLP1,
  7. Carlo Buonomo MD4,
  8. Lynne R. Ferrari MD5,
  9. Eliot S. Katz MD2

Article first published online: 24 JUN 2009

DOI: 10.1002/lary.20551

Issue

The Laryngoscope

The Laryngoscope

Volume 119, Issue 9, pages 1797–1802, September 2009

Additional Information

How to Cite

Rahbar, R., Chen, J. L., Rosen, R. L., Lowry, K. C., Simon, D. M., Perez, J. A., Buonomo, C., Ferrari, L. R. and Katz, E. S. (2009), Endoscopic repair of laryngeal cleft type I and type II: When and why?. The Laryngoscope, 119: 1797–1802. doi: 10.1002/lary.20551

Author Information

  1. 1

    Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

  2. 2

    Division of Pulmonary, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

  3. 3

    Division of Gastroenterology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

  4. 4

    Department of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

  5. 5

    Department of Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

  6. 6

    Department of Pediatric Pulmonary Medicine, Emory University School of Medicine, Atlanta, Georgia, U.S.A.

*Department of Otolaryngology and Communication Enhancement, 300 Longwood Avenue, Boston, MA 02115

Publication History

  1. Issue published online: 27 AUG 2009
  2. Article first published online: 24 JUN 2009
  3. Manuscript Accepted: 30 APR 2009

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Keywords:

  • Laryngeal cleft;
  • aspiration;
  • airway endoscopy

Abstract

Objectives/Hypothesis:

To evaluate the clinical features of children with type I and type II laryngeal cleft and the role of conservative monitoring versus endoscopic repair in their management.

Methods:

Clinical presentation and evaluation; findings at the time of laryngoscopy, bronchoscopy, and esophagoscopy; and efficacy and outcome of conservative monitoring and endoscopic CO2 laser repair.

Results:

Eighty-one patients were evaluated for aspiration. Seventy-four patients were diagnosed as having a clinically significant laryngeal cleft. Thirty-two patients (14 males, 18 females) were monitored conservatively. Forty-nine patients (26 males, 23 females) required surgical intervention due to failed medical and feeding therapy of aspiration related to their laryngeal clefts (28 type I, 21 type II). Endoscopic CO2 laser repair was used in all these patients.

Conclusions:

Medical and feeding therapy should be the first modality of treatment in patients with laryngeal cleft type I and type II. Factors supporting surgical repair include: 1) clinically apparent aspiration with feeding, 2) severity of pulmonary status, 3) findings on modified barium swallow and chest x-ray, 4) absence of significant comorbid conditions predisposing to aspiration, 5) findings on upper aerodigestive endoscopy, and 6) poor response to medical management and feeding therapy. Laryngoscope, 2009

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