title: The clinical relevance of the submucosal cricoid cleft.
abstract: OBJECTIVE
  Although fairly uncommon and sometimes difficult to diagnose, laryngeal clefts have been well-defined in the literature. The submucosal cleft variant has been described anatomically, but not clinically. We describe a series of patients with a submucosal cricoid cleft variant and its clinical relevance.
  
  
  METHODS
  This is a case series of patients presenting with submucosal cricoid. A submucosal cricoid cleft is defined as a dehiscent posterior cricoid plate with an intact mucosal bridge.
  
  
  RESULTS
  Eight patients presented during a 4 year period from October 2002 to September 2006. Patient ages ranged from 6 days to 15 years, with a mean age of 40 months. Four patients (50%) had a submucosal cricoid cleft only while four children presented with a laryngotracheal cleft in addition to the submucosal cricoid cleft. Six patients were diagnosed with subglottic stenosis and had tracheotomies. Four patients (50%) failed laryngotracheal reconstruction (LTR) prior to submucosal cricoid cleft diagnosis. Two patients had their submucosal cricoid cleft diagnosed during initial airway reconstruction surgery. Two patients were diagnosed after feeding difficulties. The submucosal cricoid cleft was felt to be an important factor contributing to the failure of previous laryngotracheal reconstruction. Almost all of the patients (7/8) had co-morbidities. Two patients needed revision airway surgery, both successful. Four of the six patients with a tracheostomy have been decannulated.
  
  
  CONCLUSIONS
  Because of the subtle nature of its clinical presentation, submucosal cricoid cleft can be a challenging diagnostic entity, and the results of surgical reconstruction may be compromised if the cleft is undiagnosed.
authors.affiliation: Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. schraffs@hotmail.com
authors.forename: Scott A
authors.initials: SA
authors.lastname: Schraff
authors.forename: Karen B
authors.initials: KB
authors.lastname: Zur
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: David H
authors.initials: DH
authors.lastname: Darrow
authors.forename: Robin T
authors.initials: RT
authors.lastname: Cotton
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Rutter
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007829:Laryngostenosis / Q000601:surgery*; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000379:methods*; D014132:Trachea / Q000002:abnormalities* / Q000601:surgery; D016896:Treatment Outcome