title: Endoscopic surgical repair of type 3 laryngeal clefts.
abstract: OBJECTIVE
  Type 3 laryngeal clefts (LC type 3) are traditionally repaired through an open approach, which requires tracheal intubation or tracheotomy placement and risks potential wound complications.
  
  
  OBJECTIVE
  To describe the surgical technique and outcomes of endoscopic carbon dioxide laser-assisted repair in pediatric patients with LC type 3.
  
  
  METHODS
  Retrospective medical record review of 6 patients with LC type 3, diagnosed via direct laryngoscopy and rigid bronchoscopy, from January 2007 to September 2013, at a tertiary pediatric hospital.
  
  
  METHODS
  All patients underwent endoscopic carbon dioxide laser-assisted repair.
  
  
  METHODS
  Patient demographics, medical comorbidity, surgical technique, swallowing outcomes, and complications were analyzed.
  
  
  RESULTS
  Median age at diagnosis was 4 months (interquartile range [IQR], 1.6 months) and at endoscopic repair, 7.5 months (IQR, 2.1 month). Congenital anomalies were found in 4 patients (67%). Five patients (83%) had gastrostomy tubes and 2 (33%) had a Nissen fundoplication prior to cleft repair. All patients aspirated preoperatively on thickened liquids as diagnosed by modified barium swallow. Median operative time was 98.2 minutes (IQR, 16.0 minutes). Five patients (83%) had no aspiration on their 3-month follow-up modified barium swallow, and no patients developed aspiration pneumonia during the follow-up period.
  
  
  CONCLUSIONS
  Endoscopic carbon dioxide laser-assisted repair should be considered as an alternative to open repair for LC type 3 when an adequate level of anesthesia with spontaneous ventilation can be maintained throughout the procedure and there is sufficient posterior glottic exposure for laser ablation and suture placement.
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Eelam
authors.initials: E
authors.lastname: Adil
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Hasan
authors.initials: H
authors.lastname: Al Shemari
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Reza
authors.initials: R
authors.lastname: Rahbar
mesh_terms: D001003:Anal Canal / Q000002:abnormalities; D001999:Bronchoscopy; D000013:Congenital Abnormalities / Q000601:surgery*; D004724:Endoscopy; D004947:Esophagus / Q000002:abnormalities; D005260:Female; D005774:Gastrostomy; D006330:Heart Defects, Congenital / Q000150:complications; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities; D007828:Laryngoscopy; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery; D053685:Laser Therapy; D017880:Limb Deformities, Congenital / Q000150:complications; D008297:Male; D012189:Retrospective Studies; D013131:Spine / Q000002:abnormalities; D014132:Trachea / Q000002:abnormalities