Type 1 laryngeal cleft: establishing a functional diagnostic and management algorithm

Int J Pediatr Otorhinolaryngol. 2006 Dec;70(12):2073-9. doi: 10.1016/j.ijporl.2006.07.021. Epub 2006 Sep 7.


Objectives: To report our experience with all patients diagnosed with type 1 laryngeal cleft over a period of 3 years in our referral practice and to describe a functional diagnostic and management algorithm for children with this disorder.

Methods: A prospective longitudinal study in a tertiary care referral center. Twenty pediatric patients diagnosed with type 1 laryngeal cleft in a 3-year period (5/1/2002-5/1/2005) were included in this study. The incidence, presenting symptoms, diagnostic procedures, medical and surgical interventions performed, and clinical outcomes were evaluated.

Results: The incidence of type 1 laryngeal cleft was 7.6%. Among the 20 patients in this study, aspiration with thin liquids was the most common presenting symptom (18 patients, 90%). Three patients underwent modified barium swallow (MBS) alone, 3 patients underwent functional endoscopic evaluation of swallow (FEES) alone, and 11 patients underwent both MBS and FEES prior to intraoperative endoscopic evaluation. Four patients (20%) were successfully treated with conservative therapy. Sixteen patients (80%) required endoscopic surgical repair after failing a course of conservative measures. The success rate of surgical repair was 94% (15 out of 16 patients).

Conclusions: Type 1 laryngeal cleft can be challenging diagnostically. We propose a functional diagnostic and management algorithm that includes MBS, FEES, suspension laryngoscopy with bimanual interarytenoid palpation, and a trial of conservative therapy, as a way to diagnose and manage type 1 laryngeal cleft prior to consideration of surgical repair. If conservative therapy fails, then surgical intervention is indicated.

MeSH terms

  • Algorithms*
  • Child, Preschool
  • Congenital Abnormalities / diagnosis
  • Deglutition Disorders / congenital
  • Deglutition Disorders / diagnosis
  • Deglutition Disorders / physiopathology
  • Deglutition Disorders / therapy
  • Endoscopy
  • Esophagus / abnormalities
  • Esophagus / physiopathology
  • Female
  • Humans
  • Incidence
  • Infant
  • Larynx / abnormalities*
  • Larynx / physiopathology
  • Larynx / surgery
  • Male
  • Prospective Studies
  • Trachea / abnormalities*
  • Trachea / physiopathology
  • Trachea / surgery
  • Treatment Outcome