title: Diagnosis and management of type I posterior laryngeal clefts.
abstract: OBJECTIVE
  We review the diagnosis and management of type I posterior laryngeal clefts (PLCs).
  
  
  METHODS
  We performed a retrospective study at a tertiary-care children's hospital of children who were diagnosed with a PLC between January 2003 and August 2008. We studied concurrent airway anomalies, comorbidities, presenting symptoms, age at the time of aspiration resolution, and rate of aspiration resolution.
  
  
  RESULTS
  Sixty-seven children with PLCs were identified (41 boys and 26 girls). Fifty-nine had type I clefts, 6 had type II, and 2 had type III. Of the 59 type I cases, 15 (25.4%) were surgically repaired by endoscopy. Eleven of these 15 children (73.3%) have had symptomatic improvement since the surgery, and 7 of those 11 (63.6%) are tolerating thin liquids by mouth. Two of the 15 (13.3%) displayed no improvement with surgery, and 2 of the 15 (13.3%) were lost to follow-up. Forty-four of the 59 type I clefts (74.6%) were managed nonsurgically. Twenty of these 44 children (45.5%) did not present with aspiration. Twenty-four of the 44 (54.5%) presented with aspiration, and 16 of the 24 (66.7%) are now tolerating thin liquids by mouth. Seven of these 24 patients (29.2%) are still aspirating, and 1 has died. The average time to resolution of aspiration was 7.8 months for the surgical group and 13.6 months for the nonsurgical group (p = 0.19). In the surgical group, the average age at resolution of aspiration for patients who received their diagnosis at 0 to 6 months of age was 21.5 months; that for those with a diagnosis at 6 to 12 months was 27.3 months; and that for those with a diagnosis at older than 12 months was 27.3 months (p = 0.31). In the nonsurgical group, the average age at resolution of aspiration for patients who received their diagnosis at 0 to 12 months of age was 15.8 months; that for those with a diagnosis at 12 to 24 months was 27.3 months; and that for those with a diagnosis at older than 24 months was 77.3 months (p = 0.0015).
  
  
  CONCLUSIONS
  We found that (1) the reported incidence of type I PLCs is increasing; (2) type I PLCs can often present without clinical aspiration; (3) aspiration caused by type I PLCs can be managed medically or surgically; and (4) operative intervention is advantageous for patients who have severe symptoms or who have persistent aspiration after 2 years of age.
authors.affiliation: Division of Pediatric Otolaryngology, Children's Memorial Hospital, IL 60614, USA.
authors.forename: Sivi
authors.initials: S
authors.lastname: Bakthavachalam
authors.forename: James W
authors.initials: JW
authors.lastname: Schroeder
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Holinger
mesh_terms: D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome