title: Type 1 laryngeal cleft: a multidimensional management algorithm.
abstract: OBJECTIVE
  Early diagnosis and assessment in children with type 1 laryngeal cleft are essential in preventing aspiration and associated comorbidity. Appropriate use of conservative and surgical interventions in an evidence-based management strategy can improve overall outcome.
  
  
  OBJECTIVE
  To evaluate the management of care for children with type 1 laryngeal cleft in our practice and develop an updated management algorithm.
  
  
  METHODS
  We performed a review of medical records at a tertiary pediatric aerodigestive center. During a period of 7 years (July 18, 2005, to July 18, 2012), 1014 children younger than 18 years were evaluated for aspiration, choking, cough, or recurrent pneumonia. Of these, 44 children (4.3%) had a type 1 laryngeal cleft. Two were lost to follow-up; thus, 42 children were included in our final sample (28 males, 14 females).
  
  
  METHODS
  The care of 15 patients (36%) was managed conservatively, and 27 patients (64%) underwent endoscopic surgical repair of their laryngeal cleft.
  
  
  METHODS
  Assessment of our current management strategy.
  
  
  RESULTS
  Success was defined as improving when a child was able to tolerate a feeding without aspirating or resolved when the child had transitioned to tolerating thin liquids. All patients received a trial of conservative therapy. Fifteen of the 42 patients (36%) had an anatomic cleft and were able to maintain the feeding regimen; thus, conservative treatment was successful in this group. The remaining 27 patients (64%) received surgical intervention. Overall operative success rate was 21 of the 27 patients (78%). The age of the child (P < .01) and comorbid conditions (P < .001) affected the outcomes of conservative measures and surgical repair. Only 6 patients did not demonstrate resolution, 5 of whom had significant comorbidities.
  
  
  CONCLUSIONS
  Age, comorbidity status, severity of aspiration, and the ability to tolerate a feeding regimen should be taken into account when deciding on conservative or surgical management for children with a type 1 laryngeal cleft. A clinical pathway for conservative and surgical management is presented.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Ojha
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts3Department of Gastroenterology, Massachusetts General Hospital, Boston.
authors.forename: Jean E
authors.initials: JE
authors.lastname: Ashland
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital, Boston 5Pediatric Airway, Voice, and Swallowing Center, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hersh
authors.affiliation: Department of Speech-Language and Swallowing Disorders, Massachusetts General Hospital, Boston7Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Ramakrishna
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: Rie
authors.initials: R
authors.lastname: Maurer
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D000465:Algorithms; D001999:Bronchoscopy; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007828:Laryngoscopy; D007830:Larynx / Q000002:abnormalities* / Q000503:physiopathology; D008297:Male; D016896:Treatment Outcome