Endoscopic Surgical Repair of Type 3 Laryngeal Clefts

Abstract

IMPORTANCE: Type 3 laryngeal clefts (LC type 3) are traditionally repaired through an open approach, which requires tracheal intubation or tracheotomy placement and risks potential wound complications. OBJECTIVE: To describe the surgical technique and outcomes of endoscopic carbon dioxide laser-assisted repair in pediatric patients with LC type 3. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of 6 patients with LC type 3, diagnosed via direct laryngoscopy and rigid bronchoscopy, from January 2007 to September 2013, at a tertiary pediatric hospital. INTERVENTIONS: All patients underwent endoscopic carbon dioxide laser-assisted repair. MAIN OUTCOMES AND MEASURES: Patient demographics, medical comorbidity, surgical technique, swallowing outcomes, and complications were analyzed. RESULTS: Median age at diagnosis was 4 months (interquartile range [IQR], 1.6 months) and at endoscopic repair, 7.5 months (IQR, 2.1 month). Congenital anomalies were found in 4 patients (67%). Five patients (83%) had gastrostomy tubes and 2 (33%) had a Nissen fundoplication prior to cleft repair. All patients aspirated preoperatively on thickened liquids as diagnosed by modified barium swallow. Median operative time was 98.2 minutes (IQR, 16.0 minutes). Five patients (83%) had no aspiration on their 3-month follow-up modified barium swallow, and no patients developed aspiration pneumonia during the follow-up period. CONCLUSIONS AND RELEVANCE: Endoscopic carbon dioxide laser-assisted repair should be considered as an alternative to open repair for LC type 3 when an adequate level of anesthesia with spontaneous ventilation can be maintained throughout the procedure and there is sufficient posterior glottic exposure for laser ablation and suture placement.