Type 1 laryngeal cleft management: a pediatric tertiary care center case series.

Abstract

Background: Type 1 laryngeal cleft (LC) is a congenital condition that can present with coughing, choking, and aspiration. There are several management options, including laryngoplasty injections and endoscopic laser surgery. We aimed to review the clinical presentations, investigations, comorbidities, management options, recurrence, and outcomes of patients with type 1 LC in our pediatric tertiary center.

Case description: Six patients with LC type 1 were included in this case series. Their mean age was 22.5 months [standard deviation (SD): 17.1]. All patients were male, except for one. The mean weight was 12.2 kg (SD: 5.3). The mean height was 84.2 cm (SD: 23.9). All patients experienced cough and choking with feeding. Of the six patients, five had no airway symptoms and one had a stridor. In our tertiary care hospital, we initially managed patients with type 1 LC with hyaluronic acid injections for a few months, depending on the severity of the condition, followed by follow-up of the patient. If coughing and/or choking reoccur or persists, surgical repair is the next management option. Although conservative therapy has been useful for 36% of patients with type 1 LC, endoscopic surgical repair remains the optimal management choice. We advocate for injection laryngoplasty as a trial to confirm the diagnosis and anticipated benefit from endoscopic surgical repairs as it offers less invasive management option and decreases the risk of developing potentially life-threatening complications.

Conclusions: Type 1 LC is a rare congenital condition that can be managed using injections. However, endoscopic laser repair remains the gold standard treatment for type 1 LC. The risk of recurrence after initial hyaluronic acid administration is high; however, recurrent symptoms can be treated with endoscopic laser repair.