Minimally Invasive Staged Endoscopic CO2 Laser Repair of Type III Laryngo-Tracheo-Esophageal Clefts: When and How

The management of Type III laryngeal clefts has evolved over the last number of years to include endoscopic approaches in select cases. The aim of our study was to evaluate the outcomes of endoscopically managed Type III laryngeal clefts in terms of repair success, swallowing outcomes, complications, and tracheostomy decannulation rates.

A retrospective review of Type III endoscopic laryngeal cleft repairs was performed over a 15-year period (2007-2021). Data collected included demographic details, number and types of surgical interventions, surveillance airway endoscopy findings, and swallow and tracheostomy outcomes.

Nineteen patients with Type III laryngeal clefts who were treated with endoscopic carbon dioxide laser-assisted repair were included. Median patient age was 9.6 months (0.4-24.1 years) and 52% were male. Thirteen patients (68%) underwent staged repairs of between 1 and 3 procedures in total. Two patients required eventual open repair. Postoperative swallowing outcomes were available for 15 patients (78%) and demonstrated that 12 patients were tolerating thin liquids, 2 patients were thickening, and one remains unable to feed orally.

Endoscopic Type III laryngeal cleft repair is a reasonable alternative to traditional open repair in selected cases. Endoscopic closure allows for repair of Type III clefts in a staged fashion, with 68% of patients in our institution having a successful closure within three stages. In select patients, endoscopic laryngeal cleft repair is a procedure with a low morbidity profile when compared to open repair and should be considered as a surgical option whenever possible.