title: Posterior laryngeal clefts: preliminary report of a new surgical procedure using tibial periosteum as an interposition graft.
abstract: OBJECTIVE
  To present the preliminary results of a new surgical procedure for posterior laryngeal cleft repair.
  
  
  METHODS
  Retrospective study in an academic tertiary care center.
  
  
  METHODS
  The study included three male patients (age at surgery, 2, 13, and 14 mo). One presented with severe aspiration and cyanotic attacks, the two others with aspiration and recurrent chest infections. The types of laryngeal clefts included complete cleft of the cricoid with varying degrees of tracheal involvement but not further than the first six tracheal rings. Associated malformations included one VATER syndrome, one esophageal atresia, and one tracheoesophageal fistula. Surgery was performed under general anesthesia with nasotracheal intubation. A vertical anterior laryngofissure was performed. The mucosal margins of the clefts were incised and then repaired in two layers with polyglactin sutures. The original feature of this procedure was the interposition of a small piece of tibial periosteum between the two layers. This fascia graft is known to be strong and resistant in cleft palate surgery.
  
  
  METHODS
  Clinical and endoscopic follow-up was used for evaluation of results.
  
  
  RESULTS
  The three patients had successful laryngeal repair at a mean follow-up of 6 months (range, 4-14 mo).
  
  
  CONCLUSIONS
  The anterior laryngofissure provides a good surgical access to the cleft. The interposition of tibial periosteum allows durability of the cleft repair. A longer follow-up is needed to confirm these preliminary results. A computed tomography scan study and a study on the rabbit are planned in order to evaluate the outcome of these periosteal grafts.
authors.affiliation: University Paris VI, Trousseau Children's Hospital, France.
authors.forename: E N
authors.initials: EN
authors.lastname: Garabedian
authors.forename: V
authors.initials: V
authors.lastname: Ducroz
authors.forename: G
authors.initials: G
authors.lastname: Roger
authors.forename: F
authors.initials: F
authors.lastname: Denoyelle
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000002:abnormalities; D005500:Follow-Up Studies; D006801:Humans; D007820:Laryngeal Mucosa / Q000601:surgery; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery*; D010521:Periosteum / Q000637:transplantation*; D012189:Retrospective Studies; D013977:Tibia / Q000637:transplantation*