A Novel Technique for Endoscopic Type I Laryngeal Cleft Repair

Abstract

Objectives:

(1) Describe a novel technique for repair of type I laryngeal clefts. (2) Review the current literature on various techniques for repair of type I laryngeal clefts.

Methods:

A retrospective review of patients under 18 years with a type I laryngeal cleft who underwent endoscopic laryngeal cleft repair (LCR) by a single surgeon at a tertiary care otolaryngology specialty hospital using a successful novel technique from July 1, 2013, to February 14, 2014, was conducted. This technique uses electrocautery to demucosalize the cleft on a setting of 6, followed by repair of the cleft with 2 endoscopically placed sutures. Charts were assessed for age at surgery, comorbidities, diet, length of stay, complications, and outcomes.

Results:

Eleven patients were identified, with an average age of 28 months (range, 9-68 months). Eight of 11 (73%) of patients were restricted to nectar thick-diet preoperatively, 2 out of 11 (19%) to honey thick-diet, and 1 out of 11 (9%) to half-strength honey thick-diet. Postoperative swallow results were available for 7 patients. Five of 7 patients demonstrated clinical or radiographic evidence of resolution of aspiration. One had improvement of aspiration but persistent penetration, and another had continued aspiration and is being evaluated for a neurologic disorder.

Conclusions:

Although type I laryngeal clefts have traditionally been endoscopically addressed using either a cold technique or a laser to demucosalize the cleft, our technique offers an advantage over cold knife by providing improved hemostasis and broader demucosalization. In addition, when compared with the laser technique, it offers similar broad demucosalization without deeper thermal damage.