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1
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Abstract
Laryngeal webs and laryngotracheoesophageal clefts (LTECs) are rare malformations of the larynx. Both can have a wide range of symptoms. While webs typically affect voice and airway and LTECs typically affect swallowing and airway, this is not always the case. A high index of suspicion is required for timely and accurate diagnosis. A discussion of management and treatment options will be presented. Both endoscopic and open surgical techniques exist for both pathologies and will be reviewed.
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Harris VC, Dalesio NM, Clark J, Nellis JC, Tunkel DE, Lee AH, Skinner M. Postoperative respiratory complications and disposition in patients with type 1 laryngeal clefts undergoing injection or repair - A single institution experience. Int J Pediatr Otorhinolaryngol 2020; 131:109844. [PMID: 31901483 DOI: 10.1016/j.ijporl.2019.109844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Identify incidence and factors associated with respiratory complications after type 1 cleft repair. METHODS Retrospective chart review of patients who underwent cleft repair over a 5-year period performed by a single surgeon. Primary endpoint was respiratory complications (oxygen desaturation <90%). Fisher's exact test was used to identify differences between repair types (endoscopic carbon dioxide laser-assisted repair and injection laryngoplasty). Logistic regression was used to identify predictors of respiratory events. RESULTS Fifty-five patients were included. Thirty-four (62%) patients underwent endoscopic carbon dioxide laser-assisted repair and 21 (38%) underwent injection laryngoplasty. Average hospital stay for each group was 1.6 days (SD = 3.1) and 0.6 days (SD = 0.9), respectively. Desaturations occurred in three patients (9%) in the laser-assisted repair group and one patient (4%) in the injection group. All occurred within 3 h after surgery and resolved with supplemental oxygen, oral airway placement, and/or mask ventilation. Two affected patients had comorbid diagnosis of asthma (one had poor medication compliance), and one had a history of developmental delay and hypotonia. In the injection group, desaturations occurred in one patient with a history of tracheal stenosis and double aortic arch. No correlation existed between repair type and desaturation (p = 0.57). No variables were significant predictors of events. CONCLUSIONS In this cohort, respiratory events after type 1 laryngeal cleft repair occurred early in the postoperative period, in children with cardiac and pulmonary comorbidities. This suggests postoperative admission may only be necessary for a select group of patients undergoing type 1 cleft repair. However, further research is needed to determine criteria for same-day discharge.
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Affiliation(s)
- Vandra C Harris
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Nicholas M Dalesio
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - James Clark
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jason C Nellis
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - David E Tunkel
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrew H Lee
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Margaret Skinner
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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3
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Laryngeal Cleft: Diagnosis and Treatment of an Unusual Presentation in an Adult. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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4
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Leahy I, Johnson C, Staffa SJ, Rahbar R, Ferrari LR. Implementing a Pediatric Perioperative Surgical Home Integrated Care Coordination Pathway for Laryngeal Cleft Repair. Anesth Analg 2020; 129:1053-1060. [PMID: 30300182 DOI: 10.1213/ane.0000000000003821] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Pediatric Perioperative Surgical Home (PPSH) model is an integrative care model designed to provide better patient care and value by shifting focus from the patient encounter level to the overarching surgical episode of care. So far, no PPSH model has targeted a complex airway disorder. It was hypothesized that the development of a PPSH for laryngeal cleft repair would reduce the high rates of postoperative resource utilization observed in this population. METHODS Institutional review board approval was obtained for the purpose of data collection and analysis. A multidisciplinary team of anesthesiologists, surgeons, nursing staff, information technology specialists, and finance administrators was gathered during the PPSH development phase. Standardized perioperative (preoperative, intraoperative, and postoperative) protocols were developed, with a focus on preoperative risk stratification. Patients presenting before surgery with ≥1 predefined medical comorbidity were triaged to the intensive care unit (ICU) postoperatively, while patients without severe systemic disease were triaged to a lower-acuity floor for overnight observation. The success of the PPSH protocol was defined by quality outcome and value measurements. RESULTS The PPSH initiative included 120 patients, and the pre-PPSH period included 115 patients who underwent laryngeal cleft repair before implementation of the new process. Patients in the pre-PPSH period were reviewed and classified as ICU candidates or lower acuity floor candidates had they presented in the post-PPSH period. Among the 79 patients in the pre-PPSH period who were identified as candidates for the lower-acuity floor transfer, 70 patients (89%) were transferred to the ICU (P < .001). Retrospective analysis concluded that 143 ICU bedded days could have been avoided in the pre-PPSH group by using PPSH risk stratification. Surgery duration (P = .034) and hospital length of stay (P = .015) were found to be slightly longer in the group of pre-PPSH observation unit candidates. Rates of 30-day unplanned readmissions to the hospital were not associated with the new PPSH initiative (P = .093). No patients in either group experienced emergent postoperative intubation or other expected complications. Total hospital costs were not lower for PPSH observation unit patients as compared to pre-PPSH observation unit candidates (difference = 8%; 95% confidence interval, -7% to 23%). CONCLUSIONS A well-defined preoperative screening protocol for patients undergoing laryngeal cleft repair can reduce postoperative ICU utilization without affecting patient safety. Further research is needed to see if these findings are applicable to other complex airway surgeries.
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Affiliation(s)
- Izabela Leahy
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Connor Johnson
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Steven J Staffa
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Reza Rahbar
- Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Lynne R Ferrari
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Garcia-Lopez I, Perez-Fernandez CA, Garcia-Raya P, Gavilan J. Laryngeal cleft: Diagnosis and treatment of an unusual presentation in an adult. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:122-124. [PMID: 31530375 DOI: 10.1016/j.otorri.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Isabel Garcia-Lopez
- Servicio de Otorrinolaringología, IdiPAZ Instituto de Investigación, Hospital Universitario La Paz, Madrid, España.
| | | | - Pilar Garcia-Raya
- Servicio de Neurorradiología, Hospital Universitario La Paz, Madrid, España
| | - Javier Gavilan
- Servicio de Otorrinolaringología, IdiPAZ Instituto de Investigación, Hospital Universitario La Paz, Madrid, España
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Ma Y, Naunheim MR, Gregory J, Woo P. Transoral Tubed Supraglottoplasty: A New Minimally Invasive Procedure for Aspiration. Ann Otol Rhinol Laryngol 2019; 128:1122-1128. [DOI: 10.1177/0003489419862581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:We describe a new procedure for aspiration called tubed supraglottoplasty (TS). TS is a transoral procedure that approximates the aryepiglottic (AE) folds and arytenoids. This narrows the laryngeal inlet. This procedure has been used to improve swallowing and reduce aspiration in patients with vocal fold paralysis. We describe the technical aspects of TS and report on 11 patients.Methods:TS is done by oral intubation followed by suspension laryngoscopy. An incision is made along the AE fold into the posterior commissure and then continued to the opposite AE fold. Dissection within this incision creates two mucosal flaps, one based on the laryngeal surface and the other on the pharyngeal surface. Two 1-cm releasing incisions are made at each end of the AE fold. The laryngeal mucosal flap is approximated using a 3-0 self-locking running suture. The pharyngeal mucosal flap is approximated as a second layer. This double-layered mucosal V-Y advancement flap builds up the posterior laryngeal height. It narrows and “tubes” the supraglottis.Results:All patients tolerated TS without airway complications. Ten of the 11 patients reported improved swallowing function with less aspiration. Six of the 8 patients with prior G-tubes had their gastrostomy tube removed. Postoperative laryngoscopy showed a narrowed “tubed” supraglottis with a higher posterior wall preventing spillover and aspiration. An improved Functional Oral Intake Scale was recorded in ten of eleven patients.Conclusion:TS is a minimally invasive procedure that can improve swallowing and reduce aspiration.
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Affiliation(s)
- Yue Ma
- University of California, Los Angeles, USA
| | | | - Jill Gregory
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Isaac A, El-Hakim H. Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review. Clin Otolaryngol 2018; 44:107-113. [DOI: 10.1111/coa.13223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Andre Isaac
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery; Departments of Surgery and Pediatrics; The Stollery Children's Hospital; University of Alberta Hospital; Edmonton AB Canada
| | - Hamdy El-Hakim
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery; Departments of Surgery and Pediatrics; The Stollery Children's Hospital; University of Alberta Hospital; Edmonton AB Canada
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Irace AL, Walker RD, Kawai K, Maddock M, Dombrowski ND, Sideridis G, Ferrari L, Rahbar R. Development and validation of a quality of life instrument for patients with laryngeal cleft. Int J Pediatr Otorhinolaryngol 2018; 108:143-150. [PMID: 29605344 DOI: 10.1016/j.ijporl.2018.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/09/2018] [Accepted: 02/25/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop and validate a novel pediatric health-related quality of life (HR-QoL) instrument for patients with laryngeal cleft and their families. METHODS We surveyed primary caregivers of patients that underwent endoscopic repair of Type I or II laryngeal cleft. The proposed HR-QoL instrument consists of 40 items representing four domains, assessing the patient's physical symptoms, the patient's and family's social functioning, and the family's emotions regarding the patient's illness pre- and post-operatively. Confirmatory factor analysis was employed to assess construct validity, dimensionality, and optimal simple structure. RESULTS Of 78 eligible participants reached by phone, 40 (51%) of them completed the questionnaire. Confirmatory factor analysis suggested that all four measured constructs were well supported by the measured items in comparison to a unidimensional model. All factor loadings and factor correlations were significant and factor correlations ranged between 0.723 and 0.879. Indices of test-retest reliability and internal consistency reliability were well above recommended standards. There was a significant correlation between current instrument and PedsQL™ score. The overall QoL score significantly improved from 112.3 (±28.1) before surgery to 158.0 (±28.5) after surgery (mean difference 45.7; 95% CI: 37.3, 54.1; p < 0.001). CONCLUSION Our proposed pediatric HR-QoL instrument is a valid tool for measuring quality of life in patients with laryngeal cleft and their families. This instrument can provide insight into the effects of medical and surgical therapy and guide pre- and post-operative management of laryngeal cleft.
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Affiliation(s)
- Alexandria L Irace
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States
| | - Ryan D Walker
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States
| | - Kosuke Kawai
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States; Department of Otolaryngology, Harvard Medical School, United States
| | - Meaghan Maddock
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States
| | - Georgios Sideridis
- Clinical Research Center, Boston Children's Hospital, Harvard Medical School, United States
| | - Lynne Ferrari
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, United States; Department of Anaesthesia, Harvard Medical School, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States; Department of Otolaryngology, Harvard Medical School, United States.
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9
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Berzofsky CE, Lando T, Ettema S, Nelson J, Woodson G. Indications for Surgical Repair of Type 1 Laryngeal Cleft. Ann Otol Rhinol Laryngol 2018; 127:217-222. [DOI: 10.1177/0003489417752187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Craig E. Berzofsky
- ENT Faculty Practice, LLP/New York Medical College, Arsdley, New York, USA
| | - Tali Lando
- ENT Faculty Practice, LLP/New York Medical College, Arsdley, New York, USA
| | - Sandra Ettema
- Southern Illinois University, Springfield, Iliinois, USA
| | | | - Gayle Woodson
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Management of Type I and Type II laryngeal clefts: controversies and evidence. Curr Opin Otolaryngol Head Neck Surg 2017; 25:506-513. [DOI: 10.1097/moo.0000000000000414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Walker RD, Irace AL, Kenna MA, Urion DK, Rahbar R. Neurologic Evaluation in Children With Laryngeal Cleft. JAMA Otolaryngol Head Neck Surg 2017; 143:651-655. [PMID: 28384788 DOI: 10.1001/jamaoto.2016.4735] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Referral to a neurologist and imaging play important roles in the management of laryngeal cleft. Swallowing involves a complex series of neuromuscular interactions, and aspiration can result from anatomical causes (eg, laryngeal cleft), neuromuscular disorders, or some combination thereof. To date, no protocols or guidelines exist to identify which patients with laryngeal cleft should undergo neuroimaging studies and/or consultation with a neurologist. Objective To establish guidelines for neurologic evaluation and imaging techniques to identify or rule out neuromuscular dysfunction in children with laryngeal cleft. Design Retrospective review of the medical records of 242 patients who were diagnosed with laryngeal cleft at a tertiary children's hospital between March 1, 1998, and July 6, 2015. Based on this review, an algorithm to guide management of laryngeal cleft is proposed. Main Outcomes and Measures Data extracted from patient medical records included the type of laryngeal cleft, details of neurologic referral, results of neuroimaging studies, and objective swallow study outcomes. Results Of the 242 patients, 142 were male and 100 were female. Mean age at the time of data analysis was 8.7 years (range, 10 months to 25 years), and there were 164 type I clefts, 64 type II, 13 type III, and 1 type IV. In all, 86 patients (35.5%) were referred to a neurologist; among these, 33 (38.4%) had examination findings indicative of neuromuscular dysfunction or dyscoordination (eg, hypotonia, spasticity, or weakness). Abnormal findings were identified in 32 of 50 patients (64.0%) who underwent brain imaging. Neurosurgical intervention was necessary in 3 patients diagnosed with Chiari malformation and in 1 patient with an intraventricular tumor detected on neuroimaging. Conclusions and Relevance A substantial proportion of patients with laryngeal cleft have coexistent neuromuscular dysfunction as a likely contributing factor to dysphagia and aspiration. Collaboration with a neurologist and appropriate neuroimaging may provide diagnostic and prognostic information in this subset of patients. At times, imaging will identify critical congenital malformations that require surgical treatment.
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Affiliation(s)
- Ryan D Walker
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandria L Irace
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Margaret A Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - David K Urion
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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Lee GS, Irace A, Rahbar R. The efficacy and safety of the flexible fiber CO2 laser delivery system in the endoscopic management of pediatric airway problems: Our long term experience. Int J Pediatr Otorhinolaryngol 2017; 97:218-222. [PMID: 28483239 DOI: 10.1016/j.ijporl.2017.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report the use of flexible fiber CO2 laser in the endoscopic management of pediatric airway cases. METHODS A retrospective review was conducted of patients who underwent CO2 laser-assisted airway procedures between September 2007 and January 2014 at a tertiary pediatric hospital. RESULTS Sixty-eight patients underwent 80 procedures utilizing flexible fiber CO2 laser. Procedures included supraglottoplasty (n = 32), laryngeal cleft repair (type I [n = 10], type II [n = 7], type III [n = 6]), suprastomal granuloma excision (n = 6), cordotomy (n = 4), laryngeal neurofibroma excision (n = 4), laryngeal granulomatous mass excision (n = 1), subglottic stenosis excision (n = 6), division of glottic web (n = 2), subglottic cyst excision (n = 1), and supraglottic biopsy (n = 1). Ages ranged from 8 days to 21 years (median 11 months). No intraoperative or postoperative complications related to the use of laser were noted. CONCLUSIONS The flexible fiber CO2 laser can be safely and effectively used to address a variety of pediatric airway lesions. Previously, the use of CO2 laser in minimally invasive airway surgery has been limited due to the articulating arm carrier, absence of a hand piece, and the direct line-of sight view required. The fiber allows the cutting beam to be directed at the site of the lesion and bypasses limitations posed by other laser systems.
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Affiliation(s)
- Gi Soo Lee
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Alexandra Irace
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
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13
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Abstract
Laryngotracheoesophageal clefts are rare congenital anomalies of the aerodigestive tract. Patients may present with airway and/or swallowing impairments. An approach to evaluation and management is presented. Important pearls for conservative and surgical management are discussed. Open versus endoscopic surgical techniques are reviewed.
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Affiliation(s)
- Julie E Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, Western University, 800 Commissioners Rd. E., London, Ontario, Canada
| | - Reza Rahbar
- Department of Otolaryngology, Communication Enhancement, Harvard University, Boston Children's Hospital, 300 Longwood Ave, LO-367, Boston, MA 02115.
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14
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Yalamachili S, Virk JS, Bajaj Y. Diagnosis and management of laryngeal cleft: A single centre experience and a novel endoscopic technique. World J Otorhinolaryngol 2015; 5:105-109. [DOI: 10.5319/wjo.v5.i4.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/23/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the presentation, diagnosis and outcomes of patients with laryngeal cleft.
METHODS: An 18 mo (from mid-2012 to 2013) prospective longitudinal study was performed at the Barts Children’s and Royal London Hospital, a tertiary referral centre. Chart review was performed for all patients including data extraction of demographics, outpatient clinic review documentation, speech therapy findings, medication list, operative findings alongside technique and follow up. A systematic review of contemporary English medical literature was also reviewed to compare series. The study was approved and registered by the hospital clinical governance and audit board. Biostatistician review was not required.
RESULTS: Twenty-two children aged 1 to 72 mo (mean age 23.5 mo) with a 7:4 male-female ratio. Twenty had Benjamin-Evans type 1 clefts and 2 had a type 2 cleft. All were symptomatic despite medical management including anti-reflux therapy. Patients presented with dyspnoea (81%), feeding difficulty (63%), stridor (54%) and recurrent pneumonia (36%). Several patients had concomitant aerodigestive abnormalities including 7 with laryngomalacia, 4 subglottic stenosis, 2 subglottic webs and 1 tracheo-oesophageal fistula. To date, 18 patients have undergone endoscopic repair, all of whom have shown radiological and/or clinical signs of improvement. All endoscopic repairs were performed with the novel use of a Negus knot pusher, with Baby Benjamin rigid suspension, to more reliably and easily suture at depth.
CONCLUSION: This is a significant single unit series demonstrating the strong association of laryngeal cleft with combined aerodigestive symptoms and other laryngeal abnormalities. Endoscopic management of type 1 and 2 laryngeal clefts is successful. We recommend the use of a Negus knot pusher to facilitate endoscopic repair.
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Macías-Rodríguez DH, Martín-Hernández R, Muñoz-Herrera ÁM, Benito-González F. Laryngeal Cleft: Diagnosis and Endoscopic Surgical Treatment. Report of 2 Cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2013.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hawley KA, White DR. Type 1 Laryngeal Clefts: An Updated Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-014-0068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Alexander NS, Liu JZ, Bhushan B, Holinger LD, Schroeder JW. Postoperative Observation of Children after Endoscopic Type 1 Posterior Laryngeal Cleft Repair. Otolaryngol Head Neck Surg 2014; 152:153-8. [DOI: 10.1177/0194599814556068] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objectives To report the perioperative management and surgical outcomes in a large series of pediatric patients with endoscopically repaired type 1 posterior laryngeal cleft (PLC). Study Design Case series with chart review. Setting Urban, tertiary care, free-standing pediatric hospital. Subjects and Methods Patients who underwent endoscopic carbon dioxide laser–assisted repair of type 1 posterior laryngeal clefts between January 2006 and December 2012. Medical records were reviewed. Results Fifty-four patients (34 male) underwent repair of type 1 PLC. Median age was 25.5 months (range, 2-120 months). Indications for repair included aspiration (n = 39; 72%), chronic bronchitis (n = 13; 24%), and stridor with feeds (n = 2; 4%). No children remained intubated postoperatively. Thirty-three patients (61%) stayed in overnight observation (“Obs PLC”) and 21 patients (39%) stayed in the pediatric intensive care unit (“PICU PLC”) postoperatively. Between Obs PLC and PICU PLC groups, there was no significant difference in age (mean 22 vs 30 months, respectively; P = .28). Comorbidities were similar between the groups. Symptoms improved in 41 of the 54 patients (76%). No postoperative complications were noted. Two patients required revision PLC repair. The cost of admitting a patient to a lower acuity location was estimated to be 60% less per day than cost of a PICU admission. Conclusions The endoscopic surgical repair of a type 1 PLC is successful and has a low morbidity and complication rate. Patients may be safely managed in an observation unit and without postoperative intubation. This approach achieved a marked cost reduction in postoperative care.
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Affiliation(s)
- Nathan S. Alexander
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Greenville Health System, Greenville, South Carolina, USA
| | - Judy Z. Liu
- Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bharat Bhushan
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren D. Holinger
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James W. Schroeder
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Macías-Rodríguez DH, Martín-Hernández R, Muñoz-Herrera ÁM, Benito-González F. Laryngeal cleft: Diagnosis and endoscopic surgical treatment. Report of 2 cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 66:237-40. [PMID: 24930855 DOI: 10.1016/j.otorri.2013.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 11/25/2013] [Accepted: 11/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Rubén Martín-Hernández
- Unidad de Disfagia, Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, Salamanca, España
| | - Ángel María Muñoz-Herrera
- Unidad de Disfagia, Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, Salamanca, España
| | - Fernando Benito-González
- Unidad de Disfagia, Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, Salamanca, España
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Leonardis RL, Duvvuri U, Mehta D. Transoral robotic-assisted laryngeal cleft repair in the pediatric patient. Laryngoscope 2014; 124:2167-9. [DOI: 10.1002/lary.24680] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 02/11/2014] [Accepted: 03/17/2014] [Indexed: 12/27/2022]
Affiliation(s)
| | - Umamaheswar Duvvuri
- Veterans Affairs Pittsburgh Health System & Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Deepak Mehta
- Department of Otolaryngology; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
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