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December 1995

Management of Posterior Laryngeal and Laryngotracheoesophageal Clefts

Arch Otolaryngol Head Neck Surg. 1995;121(12):1380-1385. doi:10.1001/archotol.1995.01890120038007

Objective:  To review the clinical features, associated congenital abnormalities, management, and morbidity of infants presenting with posterior laryngeal and laryngotracheal clefts.

Design:  Case series.

Setting:  Great Ormond Street Hospital for Sick Children NHS Trust, London, England.

Patients:  Consecutive sample of 44 patients presenting with posterior laryngeal and laryngotracheal clefts between December 10, 1979, and January 30, 1992.

Main Outcome Measures:  Clinical features, incidence of surgery, and associated morbidity and mortality related to different types of airway cleft.

Results:  The main presenting features were stridor and aspiration, which were more evident with the more extensive clefts. Twenty-five patients (56%) had associated congenital abnormalities. Fourteen patients (32%) were treated conservatively. Sixteen patients (36%) underwent primary endoscopic surgical repair. Eight patients (18%) underwent primary repair via an anterior laryngofissure; and six patients (14%) underwent primary repair via a lateral pharyngotomy. Eight patients (18%) required revision surgery, two (4%) of them on more than one occasion. Ten patients (23%) required fundoplication to control gastroesophageal reflux. Six patients (14%) died.

Conclusions:  The identification of an airway cleft requires a high index of suspicion. Morbidity and mortality are reduced by securing the airway, controlling gastroesophageal reflux, and using a multidisciplinary pediatric team. We recommend the anterior laryngofissure because of the ease of surgical access.(Arch Otolaryngol Head Neck Surg. 1995;121:1380-1385)