Postoperative observation of children after endoscopic type 1 posterior laryngeal cleft repair.
OBJECTIVE
To report the perioperative management and surgical outcomes in a large series of pediatric patients with endoscopically repaired type 1 posterior laryngeal cleft (PLC).


METHODS
Case series with chart review.


METHODS
Urban, tertiary care, free-standing pediatric hospital.


METHODS
Patients who underwent endoscopic carbon dioxide laser-assisted repair of type 1 posterior laryngeal clefts between January 2006 and December 2012. Medical records were reviewed.


RESULTS
Fifty-four patients (34 male) underwent repair of type 1 PLC. Median age was 25.5 months (range, 2-120 months). Indications for repair included aspiration (n = 39; 72%), chronic bronchitis (n = 13; 24%), and stridor with feeds (n = 2; 4%). No children remained intubated postoperatively. Thirty-three patients (61%) stayed in overnight observation ("Obs PLC") and 21 patients (39%) stayed in the pediatric intensive care unit ("PICU PLC") postoperatively. Between Obs PLC and PICU PLC groups, there was no significant difference in age (mean 22 vs 30 months, respectively; P = .28). Comorbidities were similar between the groups. Symptoms improved in 41 of the 54 patients (76%). No postoperative complications were noted. Two patients required revision PLC repair. The cost of admitting a patient to a lower acuity location was estimated to be 60% less per day than cost of a PICU admission.


CONCLUSIONS
The endoscopic surgical repair of a type 1 PLC is successful and has a low morbidity and complication rate. Patients may be safely managed in an observation unit and without postoperative intubation. This approach achieved a marked cost reduction in postoperative care.
Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Greenville Health System, Greenville, South Carolina, USA.
Nathan S
NS
Alexander
Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Judy Z
JZ
Liu
Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Bharat
B
Bhushan
Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Lauren D
LD
Holinger
Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA jschroeder@luriechildrens.org.
James W
JW
Schroeder
D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery; D054020:Lasers, Gas / Q000627:therapeutic use; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies
aspiration; dysphagia; posterior laryngeal cleft