title: Surgical management of type I and II laryngeal cleft in the pediatric population.
abstract: BACKGROUND
  Laryngeal clefts (LC) are congenital malformations of the upper aerodigestive tract that can cause dysphagia, aspiration, and subsequent pulmonary complications. This investigation assessed the outcomes of multidisciplinary evaluation and surgical management of type I and II LC (LC1-2) at a tertiary children's hospital.
  
  
  METHODS
  A retrospective chart review was used to identify patients who underwent repair of LC1-2 by a single surgeon.
  
  
  RESULTS
  Twenty-five patients who underwent surgical management for LC1-2 were identified. Twenty patients with LC-1 and 5 with LC-2 were included. Most common presentations were aspiration on modified barium swallow (MBS) (76%) and recurrent pulmonary infections (60%). Gastroesophageal reflux disease (GERD) was a concurrent co-morbidity in 68%. Of the 19 patients who presented with preoperative aspiration on MBS, 52.6% had evidence of improvement on their first MBS. This improved to 78.9% at the time of their most recent MBS (10 with resolution of aspiration, 5 with improved tolerance of consistencies). Two patients failed to improve from surgical repair and two had worsened aspiration on most recent MBS.
  
  
  CONCLUSIONS
  Endoscopic repair of laryngeal clefts is a well-tolerated procedure. Concurrent GERD and positive bronchoalveolar lavage (BAL) cultures are common and require management prior to definitive repair. Given the multidimensional nature of swallowing disorders and aspiration, a comprehensive team approach in the evaluation, management, and surveillance of these patients is a valuable complement to surgical repair since not all aspiration may resolve.
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Colorado Springs, CO, USA.
authors.forename: Tendy
authors.initials: T
authors.lastname: Chiang
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Brook
authors.initials: B
authors.lastname: McConnell
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Ruiz
authors.affiliation: Department of Pediatric Pulmonary Medicine, Children's Hospital Colorado, Aurora, CO, USA; Department of Pulmonology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: DeBoer
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: Jeremy.Prager@childrenscolorado.org.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Prager
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000145:classification* / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007828:Laryngoscopy; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery; D008297:Male; D063868:Patient Outcome Assessment; D053120:Respiratory Aspiration / Q000209:etiology; D012141:Respiratory Tract Infections / Q000209:etiology; D012189:Retrospective Studies
keywords: Aspiration; Laryngeal cleft; Laryngeal cleft repair