POSTERIOR LARYNGEAL CLEFTS - PRELIMINARY-REPORT OF A NEW SURGICAL-PROCEDURE USING TIBIAL PERIOSTEUM AS AN INTERPOSITION GRAFT

Objective: To present the preliminary results of a new surgical proced ure for posterior laryngeal cleft repair. Design: Retrospective study in an academic tertiary care center. Method: The study included three male patients (age at surgery, 2, 13, and 14 mo). One presented with s evere aspiration and cyanotic attacks, the two others with aspiration and recurrent chest infections. The types of laryngeal clefts included complete cleft of the cricoid with varying degrees of tracheal involv ement but not further than the first six tracheal rings. Associated ma lformations included one VATER syndrome, one esophageal atresia, and o ne tracheoesophageal fistula, Surgery was performed under general anes thesia with nasotracheal intubation. A vertical anterior laryngofissur e was performed. The mucosal margins of the clefts were incised and th en repaired in two layers with polyglactin sutures, The original featu re of this procedure was the interposition of a small piece of tibial periosteum between the two layers, This fascia graft is]known to be st rong and resistant in cleft palate surgery. Main Outcome Measure: Clin ical and endoscopic follow-up was used for evaluation of results. Resu lts: The three patients had successful laryngeal repair at a mean foll ow-up of 6 months (range, 4-14 mo), Conclusion: The anterior laryngofi ssure provides a good surgical access to the cleft. The interposition of tibial periosteum allows durability of the cleft repair, A longer f ollowup is needed to confirm these preliminary results. A computed tom ography scan study and a study on the rabbit are planned in order to e valuate the outcome of these periosteal grafts.