Type 1 laryngeal cleft: Establishing a functional diagnostic and management algorithm

Wade Chien, Jean Ashland, Kenan Haver, Stephen C. Hardy, Paula Curren, Christopher J. Hartnick

Research output: Contribution to journalArticle

Abstract

Objectives: To report our experience with all patients diagnosed with type 1 laryngeal cleft over a period of 3 years in our referral practice and to describe a functional diagnostic and management algorithm for children with this disorder. Methods: A prospective longitudinal study in a tertiary care referral center. Twenty pediatric patients diagnosed with type 1 laryngeal cleft in a 3-year period (5/1/2002-5/1/2005) were included in this study. The incidence, presenting symptoms, diagnostic procedures, medical and surgical interventions performed, and clinical outcomes were evaluated. Results: The incidence of type 1 laryngeal cleft was 7.6%. Among the 20 patients in this study, aspiration with thin liquids was the most common presenting symptom (18 patients, 90%). Three patients underwent modified barium swallow (MBS) alone, 3 patients underwent functional endoscopic evaluation of swallow (FEES) alone, and 11 patients underwent both MBS and FEES prior to intraoperative endoscopic evaluation. Four patients (20%) were successfully treated with conservative therapy. Sixteen patients (80%) required endoscopic surgical repair after failing a course of conservative measures. The success rate of surgical repair was 94% (15 out of 16 patients). Conclusions: Type 1 laryngeal cleft can be challenging diagnostically. We propose a functional diagnostic and management algorithm that includes MBS, FEES, suspension laryngoscopy with bimanual interarytenoid palpation, and a trial of conservative therapy, as a way to diagnose and manage type 1 laryngeal cleft prior to consideration of surgical repair. If conservative therapy fails, then surgical intervention is indicated.

Original languageEnglish (US)
Pages (from-to)2073-2079
Number of pages7
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume70
Issue number12
DOIs
StatePublished - Dec 1 2006
Externally publishedYes

Keywords

  • Aspiration
  • Cough
  • Functional endoscopic evaluation of swallow
  • Laryngeal cleft
  • Laryngoplasty
  • Modified barium swallow

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

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