Type 1 laryngeal cleft: establishing a functional diagnostic and management algorithm.
OBJECTIVE
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.
Chien
Wade
W
Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, MA 02114, United States. wadechien@hotmail.com
Ashland
Jean
J
Haver
Kenan
K
Hardy
Stephen C
SC
Curren
Paula
P
Hartnick
Christopher J
CJ
D000465:Algorithms; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis; D003680:Deglutition Disorders / Q000151:congenital / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D004724:Endoscopy; D004947:Esophagus / Q000002:abnormalities / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007830:Larynx / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D014132:Trachea / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome