Management of posterior laryngeal and laryngotracheoesophageal clefts

Arch Otolaryngol Head Neck Surg. 1995 Dec;121(12):1380-5. doi: 10.1001/archotol.1995.01890120038007.

Abstract

Objective: To review the clinical features, associated congenital abnormalities, management, and morbidity of infants presenting with posterior laryngeal and laryngotracheal clefts.

Design: Case series.

Setting: Great Ormond Street Hospital for Sick Children NHS Trust, London, England.

Patients: Consecutive sample of 44 patients presenting with posterior laryngeal and laryngotracheal clefts between December 10, 1979, and January 30, 1992.

Main outcome measures: Clinical features, incidence of surgery, and associated morbidity and mortality related to different types of airway cleft.

Results: The main presenting features were stridor and aspiration, which were more evident with the more extensive clefts. Twenty-five patients (56%) had associated congenital abnormalities. Fourteen patients (32%) were treated conservatively. Sixteen patients (36%) underwent primary endoscopic surgical repair. Eight patients (18%) underwent primary repair via an anterior laryngofissure; and six patients (14%) underwent primary repair via a lateral pharyngotomy. Eight patients (18%) required revision surgery, two (4%) of them on more than one occasion. Ten patients (23%) required fundoplication to control gastroesophageal reflux. Six patients (14%) died.

Conclusions: The identification of an airway cleft requires a high index of suspicion. Morbidity and mortality are reduced by securing the airway, controlling gastroesophageal reflux, and using a multidisciplinary pediatric team. We recommend the anterior laryngofissure because of the ease of surgical access.

MeSH terms

  • Abnormalities, Multiple / diagnosis
  • Abnormalities, Multiple / mortality
  • Abnormalities, Multiple / surgery
  • Cause of Death
  • Chromosome Aberrations / diagnosis
  • Chromosome Aberrations / mortality
  • Chromosome Disorders
  • Esophagus / abnormalities*
  • Esophagus / surgery
  • Humans
  • Larynx / abnormalities*
  • Larynx / surgery
  • Respiratory Sounds / diagnosis
  • Trachea / abnormalities*
  • Trachea / surgery