Outcomes and predictors of surgical management in type 1 laryngeal cleft swallowing dysfunction

Thottam, Prasad John; Georg, Matthew W.; Chi, David; Mehta, Deepak

doi:10.1002/lary.26069

Cited by 31 publications

(50 citation statements)

References 22 publications

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“…Almost all authors reported a high prevalence of co‐morbidities in patients with LC1. The most commonly reported medical conditions were gastro‐oesophageal reflux disease (GERD) in up to 70% of patients, and prematurity at birth in up to 36%, as well as asthma, chronic lung disease (CLD), laryngomalacia (LM), tracheo‐oesophageal fistula (TEF) and cardiovascular anomalies . Of particular note is the relatively high prevalence of LC in patients with oesophageal atresia (EA) with or without TEF.…”

Section: Presentationmentioning

confidence: 99%

“…This behoves the clinician to carefully rule out the presence of an oesophageal anomaly or TEF in patients with suspected LC1, since many TEF subtypes can in fact present subtly. Different series have also reported a wide variation (up to 30%‐50%) in associated neurological conditions and hypotonia . Several syndromes have also been linked to LC1 including VACTERL association, Pallister‐Hall syndrome, CHARGE association, Down syndrome, Opitz‐Frias syndrome, Townes‐Brock syndrome and Williams’ syndrome .…”

Section: Presentationmentioning

confidence: 99%

“…This rests on the observation that many patients with FSD, without other explanations and no convincing laryngeal anatomic defect, in fact, responded well to interventions that augmented the inter‐arytenoid area, with resolution of their clinical picture regardless of the technique employed . However, care must be taken to not confuse a functional LC1 with another non‐anatomic cause for FSD such as a neurological condition or hypotonia, given the high degree of association of these disorders with FSD …”

Section: Diagnostic Technique For Lc1mentioning

confidence: 99%

“…Whereas the earliest descriptions reported open approaches to repair, the standard of care has become using the endoscopic route. The most commonly described technique makes use of a laser to denude the mucosa of the inter‐arytenoid area, creating a diamond‐shaped incision including the mucosa at the apex of the cleft, with optional creation of anterior and posterior microflaps . Although carbon dioxide (CO2) laser has been most commonly used, with a setting of 3‐4 watts, 0.1‐0.3 second intermittent mode and 2mm spot size, potassium titanyl phosphate (KTP) laser has also been employed .…”

Section: Management: Surgical Repairmentioning

confidence: 99%

“…Although carbon dioxide (CO2) laser has been most commonly used, with a setting of 3‐4 watts, 0.1‐0.3 second intermittent mode and 2mm spot size, potassium titanyl phosphate (KTP) laser has also been employed . The mucosal edges are then approximated using either vicryl (4‐0 to 6‐0) or polydioxanone (PDS, 4‐0 to 7‐0) absorbable sutures on a reverse cutting needle where a single purse‐string suture or multiple buried interrupted sutures may be applied . One author reported the use of a trans‐oral robotic approach, although this is not commonplace and may prolong the operative time due to the involved set‐up time …”

Section: Management: Surgical Repairmentioning

confidence: 99%

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Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review

Isaac

El‐Hakim

2018

Clinical Otolaryngology

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Laryngeal cleft (LC) is a congenital anomaly of the aerodigestive tract that has gained increased attention in the recent literature. The evaluation, diagnosis and management of the mildest and most controversial form of the disease, termed type 1 laryngeal cleft (LC1), have been repeatedly cited in the context of feeding and swallowing disorders in children (FSD), mostly in North American literature. 1-7 The purpose of this article is to review the current state of the literature on LC1 in the context of managing the child with FSD and provide a summary of current diagnostic and management strategies, as well as ongoing challenges. | EMBRYOLOGYDuring embryological development, the trachea and oesophagus initially share a common lumen, and are later separated by a septum, which is normally fully formed by 35 days gestation. 8 The occurrence of LC is caused by a failure of the posterior cricoid and laryngeal tissues to fuse during development, resulting in a communication between the larynx/trachea and the hypopharynx/ oesophagus. This arrest of fusion can occur at any point between the 5th and 7th weeks of gestation, resulting in varying degrees of clefting. 9,10 The end result is a partial communication between the airway and digestive tract that can cause feeding and swallowing disorders (FSD) and/or airway distress of varying severity.

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Section: Presentationmentioning

confidence: 99%

Section: Presentationmentioning

confidence: 99%

Section: Diagnostic Technique For Lc1mentioning

confidence: 99%

Section: Management: Surgical Repairmentioning

confidence: 99%

Section: Management: Surgical Repairmentioning

confidence: 99%

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Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review

Isaac

El‐Hakim

2018

Clinical Otolaryngology

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Mucocele formation following laryngeal cleft injection

2018

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Interarytenoid injection outcomes in pediatric feeding disorders

Stack-Pyle

Carrasco²,

Shah

et al. 2023

Laryngoscope Investig Oto

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ObjectivesType 1 laryngeal clefts (LC1) and deep interarytenoid grooves contribute to pediatric feeding disorders. Management of these defects remains heterogeneous among surgeons and interarytenoid injection augmentation (IIA) is not always offered as a treatment option. This study evaluated IIA outcomes among a pediatric patient cohort comprised mostly of those with deep interarytenoid grooves.MethodsA single‐institution retrospective chart review featured children under the age of 5 years presenting for aspiration, dysphagia, or choking. Over the period of 7 years (January 2014–October 2021), 39 met inclusion criteria and had sufficient follow‐up data. Descriptive statistics and subgroup analyses were performed.ResultsOf the 39 included patients, 76.92% had clinical improvement post‐injection, with the mean time to follow‐up being 47 days. Within the deep interarytenoid groove group, improvement rates were 82.76%. Bronchoscopy findings revealed 29 (74.36%) patients with a DIG, 3 (7.69%) with LC1, 3 (7.69%) with no anatomic abnormality, and 4 (10.26%) with vocal cord paralysis. There were no adverse events. There were no associations with the outcomes based on subgroup analysis and logistic regression.ConclusionsIIA is an effective and safe treatment for pediatric feeding disorders. No covariates were associated with symptom improvement. Within the deep interarytenoid groove diagnosis subgroup, IIA effectively improved symptoms. Further investigations are needed to explore predictors of success with IIA in this population.Level of EvidenceVI.

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Outcomes and predictors of surgical management in type 1 laryngeal cleft swallowing dysfunction

Abstract: 4. Laryngoscope, 126:2838-2843, 2016.

Cited by 31 publications

References 22 publications

Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review

Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review

Mucocele formation following laryngeal cleft injection

Interarytenoid injection outcomes in pediatric feeding disorders

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