Diagnosis and determination of the clinical significance of type 1A laryngeal clefts by gelfoam injection

Laryngeal clefts are rare congenital disorders, classified by multiple diff erent schemes. Type IA (Armitage) and type I (Benjamin and Inglis) laryngea l clefts exhibit absence or hypoplasia of the interarytenoid muscles with a n intact cricoid ring. Submucous or "occult" clefts occur with intact mucos a but absent underlying cartilage and/or muscle. Children with a diagnosis of posterior laryngeal cleft often have other congenital anomalies or medic al disorders, including gastroesophageal reflux, tracheomalacia, syndrome c omplexes, and developmental delay. These associated disorders often confuse the diagnostic picture, as they may contribute to or account for the prese nting symptoms of a laryngeal cleft. We propose a method to help clarify th e clinical significance of the laryngeal clefts in these patients, and dete rmine which patients would benefit from cleft repair. Eight patients with t ype IA laryngeal clefts are presented who were treated with a "test dose" G elfoam injection into the interarytenoid area at the time of endoscopic dia gnosis. All patients exhibited clinical improvement, and 4 patients showed improvement on the postinjection videofluoroscopic swallow study as compare d to preoperative studies. One patient has gone on to surgical repair of th e cleft after multiple injections. Endoscopic Gelfoam injection at the time of diagnosis can both alleviate symptoms and provide clarification of the posterior laryngeal cleft's contribution to the clinical status of the pati ent in these often complex cases.