Published online Nov 28, 2015. doi: 10.5319/wjo.v5.i4.105
Peer-review started: June 26, 2015
First decision: August 16, 2015
Revised: August 23, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: November 28, 2015
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.
Core tip: Laryngeal cleft is a rare laryngo-tracheal wall abnormality. Patients may present with laryngeal or respiratory symptoms. A high index of suspicion is required. A multi-disciplinary team, including speech therapy and otorhinolaryngology, is required to manage these patients. Endoscopic surgical repair is increasingly the gold standard for symptomatic patients. We propose the use of the Negus knot pusher to facilitate endoscopic repair procedures.