Clinical course following endoscopic repair of type 1 laryngeal clefts

Int J Pediatr Otorhinolaryngol. 2008 Aug;72(8):1261-7. doi: 10.1016/j.ijporl.2008.05.008. Epub 2008 Jun 26.


Objectives: Treatment of type I laryngeal clefts (T1LCs) remains controversial. We present our experience with 16 endoscopic T1LC repairs to evaluate the effect of patient characteristics and surgical technique on outcomes.

Methods: A retrospective study was performed. Diagnosis of T1LC was made by interarytenoid palpation during operative microlaryngoscopy. Two surgeons performed endoscopic repair using either microflap reconstruction or laser demucosalization and reapproximation. All patients received preoperative and postoperative modified barium swallow (MBS) studies. Improved MBS at 3-5 months determined success of repair. Factors contributing to success of repair were analyzed statistically.

Results: No intraoperative complications occurred. One T1LC repair dehisced after 3 months. Overall, 11 of 16 repairs (68.8%) were successful. Mean age at repair was 23.3 months. Length of stay for microflap repair was significantly shorter than for laser reapproximation (0.89 days vs. 4.6 days, p<0.001, two-tail t-test). The difference in patient age between failures and successes (21.3 months vs. 24.2 months) was non-significant (p=0.661, two-tail t-test). Success for the nine patients receiving microflap reconstruction (77.8%) vs. the seven receiving laser reapproximation (57.1%) is comparable (p=0.596, Fisher's exact test). No correlation between comorbidities and failure was found (p>0.05, Fisher's exact test).

Conclusions: This series matches the largest reported series of endoscopic T1LC repairs. Success rates were lower than in previously reported studies, and comorbidities were higher. However, comorbidities did not contribute to surgical failure. No difference in outcome was seen between the two endoscopic techniques. Microflap repair may require a shorter hospital stay.

Publication types

  • Comparative Study

MeSH terms

  • Child, Preschool
  • Endoscopy
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Laryngeal Diseases / congenital
  • Laryngeal Diseases / surgery*
  • Larynx / abnormalities*
  • Laser Therapy
  • Male
  • Surgical Flaps