Standardizing Laryngeal Cleft Evaluations: Reliability of the Interarytenoid Assessment Protocol

Coppess, Steven; Padia, Reema; Horn, David L.; Parikh, Sanjay R.; Inglis, Andrew F.; Bly, Randall A.; Dahl, John P.; Dudley, Daniel J.; Johnson, Kaalan

doi:10.1177/0194599818806283

Cited by 17 publications

(16 citation statements)

References 14 publications

(33 reference statements)

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“…We defined T1LC as an interarytenoid notch that extended to the level of the vocal cords on light palpation with a micro‐laryngeal alligator forceps during initial diagnostic laryngoscopy. A DIN was defined as an interarytenoid notch extending below the level of the false vocal folds but without reaching the level of the true vocal folds in addition to evidence suggestive of aspiration based on history, bronchoalveolar lavage, video swallow study, or functional endoscopic evaluation of swallow 2,11 …”

Section: Methodsmentioning

confidence: 99%

Endoscopic Repair of Type 1 Laryngeal Clefts and Deep Interarytenoid Notches: Cold Steel Versus Laser

et al. 2021

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Objectives/Hypothesis Endoscopic repair is the preferred surgical treatment for type 1 laryngeal clefts (T1LCs) and deep interarytenoid notches (DINs). No studies exist showing differences in repair rates using laser and cold steel. Our objective is to assess overall success and revision rate for endoscopic cleft repair and determine whether there is any difference in surgical outcomes between cold steel and laser techniques. Study Design Retrospective chart review, cohort study. Methods Retrospective review at a quaternary care pediatric hospital. Included all patients who underwent endoscopic repair for T1LCs and DINs between January 2010 and December 2019. Demographics, comorbidities, surgical data, outcomes, and revision status were collected and analyzed. We excluded patients who did not have a follow‐up at our institution. Results A total of 194 patients were identified, 14 were excluded for lack of follow‐up data so 180 were analyzed. Of these, 127 had cold steel repair and 53 had laser repair. There is no significant difference in demographics or comorbidities. In the cold steel group, 4 of 127 (3.1%) had breakdown and in the laser group, 10 of 53 (18.9%) had breakdown. Patients who failed after a cold steel repair tended to break down later (median 12.7 months) when compared to laser repairs (median 2.1 months). Nine of the 10 patients with breakdown after laser repair were noted on initial postoperative evaluation. Conclusions Endoscopic cleft repair is a well‐described and effective method for repair of T1LCs and DINs. Both cold steel and laser have high success rates; however, higher failure rates were noted in the laser repair group. Failure after laser repair may occur earlier than failure after cold steel repair. But this did not reach significance. Level of Evidence 3 Laryngoscope, 131:2805–2810, 2021

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Section: Methodsmentioning

confidence: 99%

Endoscopic Repair of Type 1 Laryngeal Clefts and Deep Interarytenoid Notches: Cold Steel Versus Laser

et al. 2021

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“…The examiner palpates the laryngeal defect under direct observation to determine its depth. 9 The nature of the examination makes the diagnosis of LC-1 variable and dependent on physician experience and training. Patients with symptoms of LC-1 are screened via imaging techniques such as a VFSS or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES).…”

Section: Introductionmentioning

confidence: 99%

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

Al-Alawneh

Caballero

DeBroux

et al. 2020

Ann Otol Rhinol Laryngol

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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.

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“…El diagnóstico endoscópico requiere la palpación del área interaritenoidea, pues algunos pueden pasar inicialmente desapercibidos. La resolución quirúrgica en pacientes sintomáticos puede realizarse por vía endoscópica o abierta 33,34 .…”

Section: Hendiduras Laringotraqueales (Clefts)unclassified

El niño con estridor persistente

2020

Andes pediatr

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El estridor es un ruido respiratorio anormal generado por obstrucción o colapso de la vía aérea laringotraqueal, de manera aguda o de evolución crónica. Existen distintas causas tanto congénitas como adquiridas capaces de producir dificultad respiratoria, que puede llegar a ser grave y con potencial riesgo vital. El diagnóstico clínico del paciente con estridor persistente debe ser complementado con un estudio endoscópico de la vía aérea y en ocasiones con imágenes, para intentar determinar el o los sitios comprometidos y posibles malformaciones asociadas. La indicación de tratamiento debe ser individualizada, considerando el estado general del paciente, las etiologías responsables, el impacto sobre la respiración y la deglución, el pronóstico y la capacidad técnica del equipo tratante, entre otras. Las alternativas pueden incluir observación, medidas no farmacológicas, medicamentos locales o sistémicos, procedimientos endoscópicos, cirugías abiertas, o bien la instalación de una traqueostomía de manera temporal o como manejo definitivo. El objetivo de esta revisión es entregar un adecuado conocimiento de la fisiopatología y la etiopatogenia del estridor pediátrico persistente, fundamental para el correcto manejo de estos pacientes complejos, que debiera realizarse idealmente en un contexto multidisciplinario.

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Standardizing Laryngeal Cleft Evaluations: Reliability of the Interarytenoid Assessment Protocol

Cited by 17 publications

References 14 publications

Endoscopic Repair of Type 1 Laryngeal Clefts and Deep Interarytenoid Notches: Cold Steel Versus Laser

Endoscopic Repair of Type 1 Laryngeal Clefts and Deep Interarytenoid Notches: Cold Steel Versus Laser

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

El niño con estridor persistente

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