Endoscopic repair of laryngeal cleft type I and type II: when and why?
OBJECTIVE
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 CO(2) 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 CO(2) 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.
Rahbar
Reza
R
Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. reza.rahbar@childrens.harvard.edu
Chen
Judy L
JL
Rosen
Rachel L
RL
Lowry
Kristen C
KC
Simon
Dawn M
DM
Perez
Jennifer A
JA
Buonomo
Carlo
C
Ferrari
Lynne R
LR
Katz
Eliot S
ES
D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D004945:Esophagoscopy; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery; D053685:Laser Therapy / Q000379:methods; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D016896:Treatment Outcome