Management of the cleft larynx and tracheoesophageal clefts

The anomaly of posterior laryngeal cleft and the more extensive laryngotracheoesophageal cleft is extremely rare. Twenty-one cases of cleft larynx are reviewed. A new, simpler clinically oriented classification of the clefts is proposed, and the difficulty in establishing the precise diagnosis is stressed. Stridor is the commonest presenting symptom in type 1 clefts, and aspiration on feeding, recurrent pneumonia, and abnormalities of cry suggest type 2 clefts. Type 3 clefts present with severe aspiration cyanosis and incipient cardiorespiratory failure. Aspiration reflux and persistent stridor are extremely common postoperative problems and are responsible for the delays in decannulation in spite of apparently successful operative closure of the clefts.