Spectrum of swallowing abnormalities in children with Type I laryngeal cleft

To describe the spectrum of swallowing abnormalities in children with Type I laryngeal cleft (LC-1) and evaluate the effect of LC-1 repair on swallowing abnormalities.

A retrospective review was performed of all consecutive children who were diagnosed with LC-1. Swallowing function was evaluated pre- and post-operatively using video fluoroscopic swallow study (VFSS). VFSS reports were used to define swallowing abnormalities and to determine penetration aspiration scale (PAS) and functional oral intake scale (FOIS). Prevalence of swallowing abnormalities, PAS, and FOIS scores were compared before and after repair of LC-1.

Fifty-seven children with LC-1 had VFSS. The majority of children (86%) had a combination of oral phase, swallow triggering, pharyngeal phase, or esophageal phase impairment. The pharyngeal phase impairment was the most prevalent abnormality (p < 0.001). Esophageal phase impairment was the least prevalent VFSS abnormality (p < 0.001). Prevalence of impaired pharyngeal phase, laryngeal penetration on thin and thick liquids, and silent aspiration was less after repair of LC-1. Fourteen patients (41%) had developmentally appropriate diet with no restrictions after surgery. Nine patients (27%) required positioning and therapy strategies while having developmentally appropriate diet. PAS score after surgery was less than PAS score prior to surgery (p < 0.001). FOIS score after surgery was not different than FOIS score before surgery.

Multiple phases of swallowing function were impaired in the majority of children with LC-1. Prevalence of swallowing abnormalities varied in the subgroups of gender, gestational age, race, and presence of comorbidity. Swallowing function improved after repair of LC-1.