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Arch Otolaryngol Head Neck Surg. 1995 Dec;121(12):1380-5.

Management of posterior laryngeal and laryngotracheoesophageal clefts.

Author information

1
Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Sick Children NHS Trust, London, England.

Abstract

OBJECTIVE:

To review the clinical features, associated congenital abnormalities, management, and morbidity of infants presenting with posterior laryngeal and laryngotracheal clefts.

DESIGN:

Case series.

SETTING:

Great Ormond Street Hospital for Sick Children NHS Trust, London, England.

PATIENTS:

Consecutive sample of 44 patients presenting with posterior laryngeal and laryngotracheal clefts between December 10, 1979, and January 30, 1992.

MAIN OUTCOME MEASURES:

Clinical features, incidence of surgery, and associated morbidity and mortality related to different types of airway cleft.

RESULTS:

The main presenting features were stridor and aspiration, which were more evident with the more extensive clefts. Twenty-five patients (56%) had associated congenital abnormalities. Fourteen patients (32%) were treated conservatively. Sixteen patients (36%) underwent primary endoscopic surgical repair. Eight patients (18%) underwent primary repair via an anterior laryngofissure; and six patients (14%) underwent primary repair via a lateral pharyngotomy. Eight patients (18%) required revision surgery, two (4%) of them on more than one occasion. Ten patients (23%) required fundoplication to control gastroesophageal reflux. Six patients (14%) died.

CONCLUSIONS:

The identification of an airway cleft requires a high index of suspicion. Morbidity and mortality are reduced by securing the airway, controlling gastroesophageal reflux, and using a multidisciplinary pediatric team. We recommend the anterior laryngofissure because of the ease of surgical access.

PMID:
7488367
[Indexed for MEDLINE]

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