Treating laryngeal clefts
Laryngeal cleft treatment has evolved over the last 30 years. In the past, most clefts went undiagnosed, and those that were found required invasive surgery through the neck or chest. Today, most laryngeal cleft surgeries are performed endoscopically through the patient’s mouth with no exterior incisions. While treatments and surgical advancements have improved the quality of life for cleft patients, methods and techniques remain diverse among the ENTs treating this birth defect.
LCN believes it is important to acknowledge these differences so that families and providers can work together to find the best path forward for each individual patient. We support the development of well-designed studies to help guide treatment and research for our community in the years to come.
Medical Disclaimer:
This site cannot and does not contain medical/health advice. The medical/health information is provided for general information and educational purposes only and is not a substitute for professional advice. Accordingly, before taking any actions based upon such information, we encourage you to consult with appropriate professionals. The use of or reliance upon any information contained on this site is done so at your own risk. This educational information is not a replacement for seeing a medical professional.
Treatment varies by doctor, facility, and country
A variety of treatment options exist for children born with a laryngeal cleft. While there is some general consensus among ENTs on how to diagnose and treat a laryngeal cleft, many different opinions exist and each doctor uses a variety of treatments and techniques based on personal preference. Differences in diagnostic and treatment approaches also exist among facilities and countries.
Regardless of the specific treatments and techniques used, the goal should be to stop aspiration, maximize the swallow, and allow breathing and speaking. Outcomes are best when using a multidisciplinary team approach that is led by a pediatric ENT and includes at least a SLP/feeding team, gastroenterologist, pulmonologist, and when necessary, a neurologist.
Treatment options:
conservative management
endoscopic procedures
open surgery
Treatment Options
Type 1
Conservative management
Endoscopic intervention
Type 2
Endoscopic repair
Type 3
Endoscopic repair
Open repair
Type 4
Open repair
In general, treatment depends on symptoms, the type/depth of the cleft, and other medical issues. While mild cleft patients may benefit from conservative management strategies, it is commonly agreed that types 2-4 will need surgical repair.
When the decision has been made to pursue an endoscopic intervention, two options currently exist: a suture repair or a temporary injection augmentation (filler). There currently is no consensus amongst ENTs regarding which option is the best starting point for type 1 clefts. About 60 percent of ENTs prefer suture repair, while about 40 percent prefer to start with a cleft injection (International Pediatric Otolaryngology Group, 2017).
Anatomy vs. physiology
“It is important to understand the difference between anatomy and physiology. Anatomy refers to the physical structures of the body, such as the larynx and esophagus. Physiology refers to how these structures function, for example, the process of swallowing.
With a mild laryngeal cleft, it is possible to have the anatomical defect, yet still have normal swallowing function. The reverse can also be true: it is possible to have swallowing dysfunction, yet no cleft or other anatomical abnormality exists.
This makes the management of mild laryngeal clefts challenging.”
Repair failure
One risk of any type of laryngeal cleft surgery is the possibility that the repair fails. This can happen if the surgical site does not heal completely and the repair ultimately reopens, either partially or completely. A variety of factors can increase this failure risk, including reflux, coughing, the use of an endotracheal tube or NG tube, and laryngeal movement. In a minority of cases, a cleft repair can fail years later. If a cleft reopens, surgeons can usually repair it again.