MANAGEMENT OF POSTERIOR LARYNGEAL AND LARYNGOTRACHEOESOPHAGEAL CLEFTS

Objective: To review the clinical features, associated congenital abno rmalities, management, and morbidity of infants presenting with poster ior laryngeal and laryngotracheal clefts. Design: Case series. Setting : Great Ormond Street Hospital for Sick Children NHS Trust, tendon, En gland. Patients: Consecutive sample of 44 patients presenting with pos terior laryngeal and laryngotracheal clefts between December 10, 1979, and January 30, 1992. Main Outcome Measures: Clinical features, incid ence of surgery, and associated morbidity and mortality related to dif ferent types of airway cleft. Results: The main presenting features we re strider and aspiration, which were more evident with the more exten sive clefts. Twenty-five patients (56%) had associated congenital abno rmalities. Fourteen patients (32%) were treated conservatively. Sixtee n patients (36%) underwent primary endoscopic surgical repair. Eight p atients (18%) underwent primary repair via an anterior laryngofissure; and six patients (14%) underwent primary repair via a lateral pharyng otomy. Eight patients (18%) required revision surgery, two (4%) of the m on more than one occasion. Ten patients (23%) required fundoplicatio n to control gastroesophageal reflux. Six patients (14%) died. Conclus ions: The identification of an airway cleft requires a high index of s uspicion. Morbidity and mortality are reduced by securing the airway, controlling gastroesophageal reflux, and using a multidisciplinary ped iatric team. We recommend the anterior laryngofissure because of the e ase of surgical access.