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[Evaluation and treatment of children's laryngeal clefts]
1Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Fudan University, 201102 Shanghai, China.
Insights
Laryngeal cleft (LC) diagnosis and management in children presents challenges. Early intervention and tailored treatments, including anti-reflux therapy and surgery, improve outcomes for most types, though type IV remains critical.
Area of Science:
- Pediatric Otolaryngology
- Congenital Anomalies
- Airway Management
Background:
- Laryngeal cleft (LC) is a rare congenital anomaly.
- Symptoms include swallowing disorders, aspiration, dyspnea, stridor, and hoarseness.
- Diagnosis and management can be challenging.
Purpose of the Study:
- To describe the diagnostic process and management of laryngeal cleft in children.
- To discuss outcomes and predictors of treatment success.
- To evaluate the effectiveness of different therapeutic approaches.
Main Methods:
- Retrospective case study of 30 children diagnosed with laryngeal cleft (LC) between January 2016 and April 2017.
- Airway evaluation using flexible and rigid endoscopy.
- Swallowing evaluation using fiberoptic endoscopic examination of swallowing (FEES) or modified barium swallow (MBS).
Main Results:
- LC types 0-I: Primarily managed with thickened liquids, anti-reflux therapy, and feeding instructions; some required surgical repair or supraglottoplasty for laryngomalacia.
- LC types II-III: Required surgical repair or tracheotomy with anti-reflux therapy; outcomes varied.
- LC type IV: All three neonates diagnosed with type IV LC did not survive.
Conclusions:
- Laryngeal cleft diagnosis and treatment require a multidisciplinary approach.
- FEES combined with laryngeal endoscopy and MBS is optimal for LC evaluation.
- Management strategies should be tailored to LC type, with early surgical intervention crucial for types II-III and critical for type IV to reduce mortality.
Abstract:
Objectives: To provide the experience about the diagnostic process and following management, and to discuss the outcome and predictors in children with laryngeal cleft (LC). Methods: A retrospective case study was conducted at an academic children's hospital. Thirty children were diagnosed as laryngeal cleft between January 2016 and April 2017.Airway evaluations were performed using both flexible and rigid endoscopy, and swallowing evaluations were performed using fiberoptic endoscopic examination of swallowing or modified barium swallow. Results: Of 30 cases, 18 were male and 12 were female, ranging in age from birth to 8 years. Two cases were diagnosed as type 0 LC, and they were offered thickened liquid without medication. Throughout follow-up, they remained asymptomatic and showed no respiratory complications. Nineteen children were diagnosed as type Ⅰ LC. Six of them were significantly improved by anti-reflux therapy and feeding instructions. Four children were concomitant with swallowing dysfunction and/or neuromuscular disorders, and they were given a tracheotomy and routine management. Another 4 children were submitted surgical repair when routine treatment failed, and their symptoms were relieved. Five children were concomitant with larygomalacia, and their symptoms were totally ameliorated by supraglottoplasty. Three children were diagnosed as type Ⅱ LC. Two of them received surgical repair and clinically improved, and the rest one was treated by anti-reflux therapy and still under follow-up. Three children were diagnosed as type Ⅲ LC. One of them was underwent surgical repair and clinically improved. Two children were tracheotomized and treated by anti-reflux therapy. Three cases were diagnosed as type Ⅳ LC at birth and no one survived. Conclusions: Laryngeal cleft is a rare congenital anomaly manifesting with a variety of symptoms, including swallowing disorder, aspirations, dyspnea, stridor and hoarseness. Diagnosis and treatment of laryngeal clefts is a challenge. The best way to evaluate the LC is FEES by laryngeal endoscopy combined with MLB. Cases with type 0-Ⅰ mostly were significantly improved by anti-reflux therapy and feeding instructions. When routine treatment failed, surgical repair is needed. All the cases with LC type Ⅱ-Ⅲ need surgical repair as soon as possible. For type Ⅳ cases, early diagnosis, appropriate treatment and management help to reduce mortality and morbidity.