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Outcomes and Resource Utilization of Endoscopic Mass-Closure Technique for Laryngeal Clefts
Karthik Balakrishnan1, Esther Cheng2, Alessandro de Alarcon3
1Department of Otorhinolaryngology-Head & Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
Insights
Endoscopic laryngeal cleft repair offers a durable solution with shorter operative times and hospital stays compared to open repair. This minimally invasive approach avoids potential open surgery complications for pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Minimally Invasive Surgery
- Airway Reconstruction
Background:
- Laryngeal clefts can impact breathing and swallowing in pediatric patients.
- Surgical repair is often necessary for significant laryngeal clefts.
- Traditional open repair techniques carry potential morbidity.
Purpose of the Study:
- To compare resource utilization and clinical outcomes of endoscopic mass-closure versus open repair for laryngeal clefts.
- Evaluate the effectiveness and efficiency of minimally invasive endoscopic techniques.
Main Methods:
- Retrospective case series with chart review at a tertiary children's hospital.
- Compared 20 pediatric patients undergoing endoscopic repair with 8 matched controls undergoing open repair.
- Analyzed demographic, clinical, and resource utilization data over a 15-year period.
Main Results:
- Endoscopic repair showed significantly shorter operative times (P = .004) and hospital stays (P < .001).
- No significant differences in tracheostomy rates, vocal fold immobility, or cleft type distribution were observed.
- All repairs were intact postoperatively; swallowing outcomes showed no significant group differences, though data was limited.
Conclusions:
- Endoscopic mass-closure repair is a durable and efficient option for laryngeal clefts, reducing operative time and hospital stay.
- Open repair may be preferred for complex cases requiring concurrent procedures or as a salvage option.
- Further investigation into postoperative swallowing function is warranted.
Objective:
To compare resource utilization and clinical outcomes between endoscopic mass-closure and open techniques for laryngeal cleft repair.
Study Design:
Case series with chart review.
Setting:
Tertiary academic children's hospital.
Subjects And Methods:
Pediatric patients undergoing repair for Benjamin-Inglis type 1-3 laryngeal clefts over a 15-year period. All 20 patients undergoing endoscopic repair were included. Eight control patients undergoing open repair were selected using matching by age and cleft type. Demographic, clinical, and resource utilization data were collected.
Results:
Twenty-eight patients were included (20 endoscopic, 8 open). Mean age, rates of tracheostomy and vocal fold immobility, and distribution of cleft types were not different between the 2 groups (all P > .2). Mean operative time (P = .004) and duration of hospital stay (P < .001) were significantly shorter in the endoscopic group. All repairs were intact in both groups at final postoperative endoscopy. Rates of persistent laryngeal penetration or aspiration on swallow study were not different between groups (P = 1.000), although results were available for only 11 patients.
Conclusion:
Endoscopic laryngeal cleft repair using a mass-closure technique provides a durable result while requiring significantly shorter operative times and hospital stays than open repair and avoiding the potential morbidity of laryngofissure. However, open repair may allow the simultaneous performance of other airway reconstructive procedures and may be a useful salvage technique when endoscopic repair fails. Postoperative swallowing results require further study.
