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    1 Comment for this article
    Sunder | Seyoung Hospital
    I have thought of this a countless times, considering the probable cause and effects of doing such.  Nevertheless, I appreciate the effort and hard work.
    Original Investigation
    November 2014

    Endoscopic Surgical Repair of Type 3 Laryngeal Clefts

    Author Affiliations
    • 1Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
    • 2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
    JAMA Otolaryngol Head Neck Surg. 2014;140(11):1051-1055. doi:10.1001/jamaoto.2014.2421

    Importance  Type 3 laryngeal clefts (LC type 3) are traditionally repaired through an open approach, which requires tracheal intubation or tracheotomy placement and risks potential wound complications.

    Objective  To describe the surgical technique and outcomes of endoscopic carbon dioxide laser–assisted repair in pediatric patients with LC type 3.

    Design, Setting, and Participants  Retrospective medical record review of 6 patients with LC type 3, diagnosed via direct laryngoscopy and rigid bronchoscopy, from January 2007 to September 2013, at a tertiary pediatric hospital.

    Interventions  All patients underwent endoscopic carbon dioxide laser–assisted repair.

    Main Outcomes and Measures  Patient demographics, medical comorbidity, surgical technique, swallowing outcomes, and complications were analyzed.

    Results  Median age at diagnosis was 4 months (interquartile range [IQR], 1.6 months) and at endoscopic repair, 7.5 months (IQR, 2.1 month). Congenital anomalies were found in 4 patients (67%). Five patients (83%) had gastrostomy tubes and 2 (33%) had a Nissen fundoplication prior to cleft repair. All patients aspirated preoperatively on thickened liquids as diagnosed by modified barium swallow. Median operative time was 98.2 minutes (IQR, 16.0 minutes). Five patients (83%) had no aspiration on their 3-month follow-up modified barium swallow, and no patients developed aspiration pneumonia during the follow-up period.

    Conclusions and Relevance  Endoscopic carbon dioxide laser–assisted repair should be considered as an alternative to open repair for LC type 3 when an adequate level of anesthesia with spontaneous ventilation can be maintained throughout the procedure and there is sufficient posterior glottic exposure for laser ablation and suture placement.