Endoscopic repair of laryngotracheoesophageal clefts

Fukumoto, Koji; Miyano, Go; Yamoto, Masaya; Nouso, Hiroshi; Kaneshiro, Masakatsu; Nakajima, Hideaki; Koyama, Mariko; Mochizuki, Kiyofumi; Sato, Masato; Urushihara, Naoto

doi:10.1016/j.jpedsurg.2015.07.018

Cited by 6 publications

(9 citation statements)

References 11 publications

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“…After the titles and abstracts were screened, 64 full-text articles were reviewed. After final review, 27 articles [1][2][3][4]8,[11][12][13][14]17,18,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were included for qualitative and quantitative analysis ( Figure 1). Of the 27 included studies, 19 were from the United States; 1 each from Saudi Arabia, Japan, Australia, Canada, and Ireland; and 3 from the United Kingdom.…”

Section: Literature Search and Risk-of-bias Assessmentmentioning

confidence: 99%

Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta‐analysis

Timashpolsky

Schild

Ballard

et al. 2020

Otolaryngol.--head neck surg.

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Objective Endoscopic surgical management or injection laryngoplasty of type 1 laryngeal clefts in pediatric patients is used in those who do not respond to conservative treatment. This study compares conservative treatment, endoscopic surgical repair, and injection laryngoplasty for the management of type 1 laryngeal clefts. Data Sources PubMed, Web of Science, and Embase. Review Methods This systematic review included studies of patients with type 1 laryngeal clefts who were managed with conservative treatment, injection laryngoplasty, or endoscopic repair, and all studies reported postintervention outcomes. Two independent investigators assessed study eligibility, rated the quality, and extracted data for analysis. A random effects model was used for meta-analysis of pooled data. Results Of the 1209 studies identified, 27 met inclusion criteria. There were 543 patients with type 1 laryngeal clefts represented in the studies, with outcomes reported for 537. Conservative therapy had a 52% (95% CI, 37%-66%; I2 = 63%) success rate at improving symptoms, while endoscopic repair had a significantly higher percentage resolution of symptoms (70%; 95% CI, 59%-79%; I2 = 62%, P < .001) as compared with conservative treatment (51%; 95% CI, 36%-65%; I2 = 62%) or injection laryngoplasty (36%; 95% CI, 20%-57%; I2 = 70%). The quality scores of the studies ranged from 7 to 12 out of 16. Conclusion Our systematic review demonstrated significant improvement and resolution of symptoms for patients with type 1 laryngeal clefts treated with endoscopic repair as compared with other modalities. More prospective and controlled studies comparing treatment strategies with validated instruments to measure outcomes are necessary to determine their efficacy in the management of type 1 laryngeal clefts.

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Section: Literature Search and Risk-of-bias Assessmentmentioning

confidence: 99%

Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta‐analysis

Timashpolsky

Schild

Ballard

et al. 2020

Otolaryngol.--head neck surg.

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“…Regarding injection augmentation, complete resolution of symptoms was reported in 39.7% to 72% of patients (20,44,49). Surgical management seemed to indicate relatively high rates of success, ranging from 73% to 100% (12,22,23,27,48,50,51). The definition of success differed between studies, they include return to normal feeding, improvement of aspiration severity and symptom resolution (15,19,40).…”

Section: Prognosismentioning

confidence: 99%

“… Objective findings on upper aerodigestive investigation/ imaging (i.e., persistence of aspiration on MBS). Fukumoto et al (50) mentioned that 2.5 kg may be sufficient for endoscopic surgery as the lowest body weight was a 1-month old infant weighing 2,460 g at surgery. However, in a research survey by Yeung et al (1), most members (65%, 13/20) did not use minimum weight as a criterion for assessing patient suitability for surgery.…”

Section: Endoscopic Surgery Surgical Repair Of a Type 1 Lc Was First mentioning

confidence: 99%

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Diagnosis and management of type 1 laryngeal cleft: systematic review

Loh¹,

Phua²,

Shaw³

2019

Aust J Otolaryngol

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Background: Laryngeal cleft (LC) poses a diagnostic challenge due to its rarity and non-specific clinical features. There is poor consensus regarding management as either conservative or surgical management may be appropriate for type 1 LC, given the spectrum of disease patients present with. The objective was to review the current literature and propose diagnostic and management pathways for type 1 LC. Methods: The study comprised a systematic review using data collected from PubMed, Medline and Cochrane library. A quality assessment of included studies was performed using a validated tool. A metaanalysis of proportions was performed for the outcome of each treatment modality using MedCalc software. Results: Of 674 potential studies, 19 were included. Complete resolution rates of conservative management, injection augmentation and endoscopic surgery were 52.3% (95% CI, 32.3-71.9%), 69.2% (95% CI, 59.1-78.1%) and 65.4% (95% CI, 49.1-80.1%) respectively. There are research survey, diagnostic and treatment algorithms, and radiological investigations presented in the literature to assist in constructing an updated management algorithm. Conclusions: We recommend that all patients receive initial 3-month trial of conservative therapy. Endoscopic surgery may be considered if conservative management fails or in the presence of other surgical indications. Injection augmentation may be performed prior to definitive surgical repair in selected patients who have comorbidities that increase aspiration risk to evaluate the potential effect of surgery.

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“…Conversely, in case of very large cyst that cannot be completely removed even via piecemeal resection or when a fistula tract cannot be grasped properly, MLS is not considered as first-line treatment for PSF. We previously reported that MLS can be applied in infants aged less than 1 year [ 21 ], and we believe that a similar procedure can be performed for PSFs in young children.…”

Section: Case Presentationmentioning

confidence: 99%

Microlaryngoscopic surgery for pyriform sinus fistulas in children: a report of two cases

et al. 2018

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BackgroundA pyriform sinus fistula (PSF) is a rare branchial anomaly that causes recurrent cervical infections. Open neck surgery has widely been accepted as a definitive treatment for PSFs, and endoscopic surgery has been reported in recent years. However, both approaches are not satisfactory because of high recurrence rates and postoperative complications. Microlaryngoscopic surgery (MLS) is a transoral surgical technique involving the use of an operating microscope. In this report, we present a new procedure involving MLS for resection and closure of a PSF without a skin incision.Case presentationTechnique: MLS was performed under general anesthesia with endotracheal intubation. The patient was placed in the supine position, and a direct laryngoscope was inserted to expose the pyriform sinus, which was then magnified using an operating microscope. The mucosal layer was carefully resected using scissors and cupped forceps with sharp edges. The fistula was securely sutured using absorbable suture material. Case 1: A 9-year-old boy with recurrent neck abscesses since 8 years of age presented to our hospital after receiving antibiotics and undergoing drainage in other hospitals. After admission to our hospital, barium esophagography and oral contrast coronal computed tomography showed a PSF on the left side, and open neck surgery was performed to resect the fistula. He was eventually discharged from the hospital without any problem. However, a PSF recurred 2 weeks later. As reoperation with the cervical approach was considered difficult owing to severe adhesions, we adopted MLS as a definitive operation. The postoperative course was uneventful. No recurrence was observed during an 18-month follow-up. Case 2: A 10-year-old girl presented to our hospital with recurrent left-sided neck swelling since 6 years of age. After inflammation control, a PSF was identified on the left side on barium esophagography and computed tomography. MLS was performed safely, and the postoperative course was uneventful. No recurrence was observed during a 10-month follow-up.ConclusionsMLS allows excellent visualization and effective closure for PSFs, and this approach is suitable for recurrence after open neck surgery. Therefore, MLS might become a first-line treatment for PSFs in children.

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Endoscopic repair of laryngotracheoesophageal clefts

Cited by 6 publications

References 11 publications

Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta‐analysis

Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta‐analysis

Diagnosis and management of type 1 laryngeal cleft: systematic review

Microlaryngoscopic surgery for pyriform sinus fistulas in children: a report of two cases

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