Injection Laryngoplasty for the Treatment of Type 1 Laryngeal Clefts: A Single Institution Experience

Abstract

Objective: Standards for treatment of laryngeal clefts remain poorly defined. There are no large case series that report the efficacy of injection laryngoplasty (IL) in the treatment of pediatric Type 1 laryngeal clefts (LC-1). The objective of this study is to measure the effect of IL in young children with LC-1. Methods: A retrospective case series of 130 patients was completed over 3 years at a at a single institution included patients aged 1 month to 8 years, diagnosed with aspiration and penetration issues during swallowing based on a Videofluoroscopic Swallow Study (VFSS). Patients underwent surgical evaluation and intervention using carboxymethylcellulose gel injection. Collected data points included age in months at time of first injection, gender, race, pre- and post-operation VFSS scores, number of injections, co-morbidities and post-operative complications. VFSS scores were evaluated pre- and post-operatively to assess efficacy of intervention. A secondary outcome was efficacy in patients with aspiration compared to those with penetration alone. Results: This study included 77 male and 53 female patients. Sixty-two patients (48%) demonstrated a significant post-operative improvement in their swallowing function ( P < .05). There were no statistical differences in age, number of injections, or the volume of the first injection. Patients that showed a post-operative improvement in swallowing function were on average 5 months older and had more severe aspiration and penetration compared to those who did not demonstrate a post-operative benefit and underwent less injections. The volume of injection did not appear to play a role in the success rate. Conclusion: Injecting the inter-arytenoid area in patients with LC-1 appears to confer some benefit to close to half of our patient population. Successful procedures seemed to occur in patients with more severe aspiration and penetration and older age.

Interarytenoid injection outcomes in pediatric feeding disorders

“…Akin to other reports, [3][4][5][6][7][8][9] our results revealed a post-injection symptom improvement rate of 76.92% in the short-term follow-up.…”

“…IIA has many benefits over endoscopic repair. Symptom improvement rates range from 42%–100% for LC1 IIA treatment 3–9,14,15 . Compared to endoscopic closure, IIA carries less risk 16 .…”

Outcomes of Injection Laryngoplasty for Deep Interarytenoid Groove

“…19 Clinical improvement of aspiration and penetration based on ability to use a less thick consistency or resolution of aspiration ranged from 48 to 57%. 20,23 In the present study, the rates of resolution of penetration (47%) and aspiration (50%) in children with DIG were comparable to previous success rates in children with type I laryngeal cleft. 21,22 The depth of the interarytenoid groove as well as differences in patient demographics and morbidities may account for higher success rate in children with DIG than that of a previous study in children with type I laryngeal cleft.…”

“…18,19 The outcomes of IA for the management of type I laryngeal cleft have been evaluated based on resolution or improvement of penetration or aspiration as detected with VFSS. [18][19][20][21][22][23] The resolution rate of aspiration after IA ranged from 13 to 56%. 18,21,22 The long-term follow-up revealed resolution of Deep Interarytenoid Groove Injection Mothersole et al…”

Repair of posterior laryngeal cleft: a 10-year experience in a tertiary referral hospital

“…But a randomised, controlled prospective study would be needed to determine the patients who would benefit from such treatment. 28 The best surgical procedure for type III and type IV clefts is still up for debate. 29,30 An open surgical approach (a transtracheal approach) was used to close most of the grade III clefts in the current study.…”