Indications for Surgical Repair of Type 1 Laryngeal Cleft

Type 1 laryngeal cleft (T1LC) is a congenital deficiency in the posterior glottis, resulting in a communication between the hypopharynx and glottis. No consensus treatment paradigm exists for timing and criteria for patient selection for surgical repair. Our goal is to assess whether patient characteristics can help predict improvement after surgery.

After Institutional Review Board exemption, a retrospective chart review was performed for patients undergoing surgery to diagnose a T1LC. Charts were examined for age, presenting symptoms, comorbidities, pre/postoperative videoflouroscopic swallow study reports, and outcomes.

Ninety-seven patients with clinical suspicion for T1LC underwent direct laryngoscopy and bronchoscopy, and 63 (64%) were diagnosed with a T1LC. Twenty-two patients (63%) undergoing surgery achieved clinical or radiographic improvement. There was no difference in average age, aspiration, or penetration between clinical improvement and no improvement groups. Of 13 patients with comorbidities that increase their risk of aspiration, 12 were significantly improved. There were 5 complications, which were managed conservatively.

Our experience supports the repair of T1LC repair at time of diagnostic laryngoscopy if satisfactory improvement is not noted with conservative treatment. This should be performed without segregation for age, comorbidities, or degree of dysphagia. Our technique is performed with minimal complications and achieves satisfactory results.