Type 3 Laryngeal Clefts Presenting with Upper Airway Obstruction without Aspiration

Area of Science:

• Otolaryngology
• Pediatric Pulmonology
• Pediatric Surgery

Background:

• Traditionally, aspiration is considered the hallmark symptom of laryngeal clefts.
• However, a subset of patients, even with extensive clefts, may present with isolated upper airway obstruction.

Observation:

• Two pediatric cases of type III laryngeal clefts are presented.
• Both patients exhibited upper airway obstruction without aspiration, one with noisy breathing and the other with exercise-induced stridor.
• Diagnostic evaluations including polysomnography and modified barium swallow were negative for aspiration, but laryngoscopy revealed suggestive findings.

Findings:

• Type III laryngeal clefts were confirmed via bronchoscopy in both patients.
• Endoscopic repair successfully resolved airway obstruction and associated symptoms in both cases.
• These findings challenge the traditional view that aspiration is the sole defining clinical feature.

Implications:

• Laryngeal cleft should be considered in the differential diagnosis for pediatric patients with unexplained obstructive airway symptoms, even in the absence of dysphagia.
• Flexible laryngoscopy can reveal suspicious features indicative of laryngeal cleft.
• Endoscopic repair of laryngeal clefts is an effective treatment for relieving obstructive symptoms and restoring normal laryngeal anatomy.