Delayed diagnosis of a laryngotracheoesophageal cleft

Laryngotracheoesophageal (LTE) clefts are rare anomalies of the airway. Surgical correction has been performed in all cases reported in the literature for clefts diagnosed during life. Posterior laryngeal clefts (PLC) are defined as minor (type I) to severe (type IV), with types III and IV being further described as LTE clefts. Type I clefts have been observed with an increased frequency of up to 6% of all pediatric direct laryngoscopies performed at a tertiary pediatric referral hospital. These can be managed medically and seldom require surgical correction. A case is presented of a boy whose initial diagnosis of LTE cleft (PLC type III) was made at age 7 years. His presenting complaints were chronic airway symptoms without airway distress. He developed only two episodes of pneumonia. Surgical correction was not performed. This young athlete has been followed for more than 6 years without significant problems. This appears to be the only case found in the literature of the successful management of a LTE cleft that has not required surgical correction. Photographic documentation and suggestions on endoscopic diagnosis are presented.