The role of direct laryngoscopy in the diagnosis of laryngeal cleft

Paul D. Neubauer, Laura H. Swibel Rosenthal, William I. Wooten III, Carlton J. Zdanski, Amelia F. Drake

Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Children’s Hospital, Chapel Hill, USA.
Department of Otolaryngology—Head and Neck Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, USA.
Department of Surgery, Section of Otolaryngology, Yale-New Haven Hospital, New Haven, USA.
Division of Pediatric Pulmonology, University of North Carolina Children’s Hospital, Chapel Hill, USA.

DOI: 10.4236/ojped.2013.32017                

Abstract

Objective: To identify the presenting features of a laryngeal cleft in children. To compare rigid and flexible endoscopic methods available for identifying laryngeal cleft and determine their utility. Methods: The charts of all patients diagnosed with laryngeal cleft in a tertiary care institution between 2009 and 2010 were evaluated retrospectively for age, gender, comorbidity, presenting features, and results of bedside swallow evaluation. Findings on flexible and direct laryngoscopy, both performed under general anesthesia, were compared. Results: Eleven patients had a diagnosis of laryngeal cleft, confirmed by direct laryngoscopy. Nine of eleven had signs of aspiration on modified barium swallow study (MBSS). Of the eight subjects who underwent flexible laryngoscopy by a pulmonologist, a deep interarytenoid groove was only reported in four cases. In all eleven cases, the arytenoids could be physically separated during direct laryngoscopy, allowing for definitive diagnosis of the cleft and identification of its type and severity. Conclusion: Video swallow studies and flexible laryngoscopy may raise suspicion or even diagnose a laryngeal cleft, however, a laryngeal cleft must be confirmed by direct laryngscopy in which the interarytenoid space is palpated. Furthermore, a patient in whom symptoms persist but no laryngeal cleft is identified on flexible examination should have a direct laryngoscopy to rule out a cleft.

Keywords

Laryngeal Cleft; Laryngoscopy; Aspiration; Children

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Watters, K. and Russell, J. (2003) Diagnosis and management of type 1 laryngeal cleft. International Journal of Pediatric Otorhinolaryngology, 67, 591-596. doi:10.1016/S0165-5876(03)00058-2
[2]	Pezzettigotta, S.M., Leboulanger, N., Roger, G., Denoyelle, F. and Garabedian, E.N. (2008) Laryngeal Cleft. Otolaryngologic Clinics of North America, 41, 913-933. doi:10.1016/j.otc.2008.04.010
[3]	Chien, W., Ashland, J., Haver, K., Hardy, S.C., Curran, P. and Hartnick, C.J. (2006) Type 1 laryngeal cleft: Establishing a functional diagnostic and management algorithm. International Journal of Pediatric Otorhinolaryngology, 70, 2073-2079. doi:10.1016/j.ijporl.2006.07.021
[4]	Evans, K.L., Courteney-Harris, R., Bailey, C.M., Evans, J.N. and Parsons, D.S. (1995) Management of posterior laryngeal and laryngotracheoesophageal clefts. Archives of Otolaryngology—Head & Neck Surgery, 121, 1380-1385. doi:10.1001/archotol.1995.01890120038007