Direct Laryngoscopy and Bronchoscopy (DLB) or Microscopic Laryngoscopy and Bronchoscopy (ML&B)
“A DLB is the current gold standard for diagnosing a laryngeal cleft. A rigid scope is used during this endoscopic evaluation, which occurs under general anesthesia in an operating room. ”
A DLB involves an ENT gently inserting a rigid laryngoscope into the larynx and then a rigid bronchoscope into the trachea to view these organs. If a laryngeal cleft is present, the DLB allows it to be seen and the depth/type to be assessed. Signs of aspiration may also be seen, as well as other related abnormalities, such as different types of airway malacia or subglottic stenosis.
Redundant mucosa
Sometimes, instead of a lack of tissue in the potential cleft area, there is extra tissue, commonly referred to as “redundant mucosa.” This can make it hard to see if there is a cleft. It is important for the area to also be palpated with a probe in case excess tissue is hiding a cleft.
Type 3 laryngeal cleft during a DLB.
DLB or ML&B
Location: Operating room
Advantages:
Able to fully view and probe the potential cleft area and upper airway.
Able to assess a cleft depth/type.
Other airway abnormalities may be seen and diagnosed.
Patient is asleep so there is no discomfort during the procedure.
Usually well tolerated by the patient.
Disadvantages:
Must be performed in the operating room using general anesthesia.
After the procedure, swelling/discomfort may occur and sometimes requires an overnight hospital stay for breathing observation.
A sore throat lasting a day or two is common.
Other risks exist and other complications may occur.