Author(s)
Isobel O'Riordan, MBBChBAO MCh
Reza Rahbar, MD
Joseph Peterson, MD
Erika Mercier, MD
Sarah Francisco, BS
Karen Watters, MBBChBAO
Lynne Ferrari MD
Affiliation(s)
Boston Children's Hospital
Abstract:
Introduction:
Endoscopic laryngeal cleft repair has become the standard of care in type I and II clefts. Traditionally type III clefts underwent open repair. Recent advances in endoscopic techniques have made repair of type III laryngotracheoesophageal clefts possible. The aim of our study was to evaluate the outcomes from our series of endoscopically managed type IIIA and IIIB laryngeal clefts.
Method: s
Following institutional review board approval, a retrospective review of all endoscopic laryngeal cleft repairs on type III clefts was performed over an 11-year period. Data collected included demographic details, surgical intervention, complications, number of procedures and swallow outcomes.
Results:
Over the study period there were 19 patients with Type III laryngeal clefts treated with endoscopic carbon dioxide LASER assisted repair. The median age was 9.6 months and 52% of cases were male patients. Primary endoscopic repair was performed in all cases. 68% of patients in our institution were treated with a 3-stage endoscopic repair. One patient required revision repair performed with an open approach. Post operative swallowing outcomes demonstrated that 7 patients (38%) were successfully transitioned to normal diet, 5 patients were being weaned off thickeners (28%), 5 patients still required thickeners (28%) and 1 patient was NPO. There were 3 post operative complications requiring a return to the operating room; 2 patients had redundant mucosa prolapsing into their airway and 1 patient had a suture granuloma requiring removal and ultimately developed a tracheoesophageal fistula which was managed surgically. There were no postoperative mortalities.
Conclusion:
Endoscopic type III laryngeal cleft repair is a viable surgical option for a subset of patients, as it allows repair of certain type III clefts in a staged fashion, without the need for open surgery or cardiopulmonary bypass. We advocate for endoscopic repair in select cases due to favorable morbidity and mortality rates.