The presentation and management of laryngeal cleft: a 10-year experience.

OBJECTIVE: To review the presentation and associated congenital abnormalities of laryngeal cleft and present guidelines for its evaluation and management. DESIGN: A 10-year retrospective study (1994-2004) with institutional review board approval. SETTING: Two pediatric tertiary care medical centers. PATIENTS: Twenty-two pediatric patients (mean age, 21 months) with laryngeal cleft. INTERVENTION: Surgical repair of laryngeal cleft. MAIN OUTCOME MEASURES: Sex, age, symptoms, other associated abnormalities, method of evaluation, type of laryngeal cleft, method of surgical repair, treatment outcome, complications, and long-term follow-up. RESULTS: All 22 patients underwent surgical repair for laryngeal cleft. Airway endoscopy confirmed the following types of laryngeal clefts: type 1 (n = 3), type 2 (n = 10), and type 3 (n = 9). Surgical repair techniques included an open approach with or without interposition graft (n = 16) and an endoscopic approach (n = 6). CONCLUSIONS: Early diagnosis and proper repair of laryngeal cleft are essential to prevent pulmonary damage and associated morbidity. Each patient should be assessed properly, and the surgical approach should be individualized based on the symptoms, other associated findings on airway endoscopy, and type of cleft.