Main Theme: Airway
Introduction
Laryngeal clefts are rare congenital structural abnormalities creating a gap between the larynx and oesophagus, arising from failure of the tracheoesophageal septum to develop. Symptoms include coughing and choking when feeding and aspiration leading to respiratory infections. Relation with genetic syndromes and neuromuscular disease1 complicates identifying if the structural gap or the associated functional swallowing issues are at fault, raising the question: should pathophysiology guide surgical management?
Methods
Retrospective review of laryngeal cleft repairs over 3.5 years. Data extracted included demographics, presentation, co-morbidities, operative findings, surgical technique and outcomes.
Results
17 laryngeal cleft repair cases were identified. 82% of children were male. Age distribution was 2-12 years. 82% had choking followed by 76% with unsafe swallow then 65% with recurrent chest infections. 18% had no co-morbidities, the remainder had gastrointestinal, neurological and/or respiratory comorbidities. All had type 1 laryngeal cleft, 41% had additional airway anomalies. 41% of repairs were performed endoscopically and 59% microscopically. Children with lack of overall symptom improvement had a greater prevalence of co-morbidities in comparison to children with overall symptom improvement (100% vs 70%).
Conclusion
Surgical repair of type 1 laryngeal clefts can confer great benefit2 and should be considered especially if morbidity is high with recurrent chest infections. Pathophysiology is important for decision-making to proceed to surgery and parents/carers should be consulted accordingly. If symptoms are due to functional swallowing issues rather than the structural gap of the laryngeal cleft then the risk of lack of improvement is higher.
References
1. Martha, V.V., Vontela, S., Calder, A.N., Martha, R.R. and Sataloff, R.T., 2021. Laryngeal cleft: a literature review. American journal of otolaryngology, 42(6), p.103072.
2. Timashpolsky, A., Schild, S.D., Ballard, D.P., Leventer, S.P., Rosenfeld, R.M. and Plum, A.W., 2021. Management of type 1 laryngeal clefts: a systematic review and meta-analysis. Otolaryngology–Head and Neck Surgery, 164(3), pp.489-500.