Laryngeal cleft type I in neonate: case report

Abstract

Laryngeal cleft (LC) is a congenital malformation that leads to the unusual communication between the esophagus and the laryngotracheal complex. It is a rare disease, mostly prevalent among male individuals. The goal of this study was to describe the evaluation and intervention by the speech language pathologist of a female newborn diagnosed with LC type I, admitted on the University Hospital of Universidade de São Paulo, in her second hospitalization due to small weight gain and pneumonia. She was submitted to a bedside clinical evaluation of the swallowing and the most important occurrence was frequent gagging. The videofluoroscopy swallowing study showed laryngotracheal aspiration level 8 for thin liquid and level 1 for thickened liquid, according to the Penetration-Aspiration Scale. The newborn was submitted to a microlaryngoscopy, in which the presence of LC type I was found. After the diagnosis, the speech language pathologist offered thickened liquid at 6% and, in 8 days, the newborn was discharged with exclusive oral diet without gagging. Eight outpatient consultations were carried out for 11 months, with emphasis on reintroduction of thin liquids. The treatment was discontinued and the patient was put on general diet for the age without modifications. Throughout follow-up, the patient remained asymptomatic and showed no respiratory complications.

Laryngeal Cleft Type I

“…5 The condition is usually associated with gastroesophageal reflux disease and genetic syndromes such as Pallister-Hall syndrome, CHARGE syndrome, VACTERL association, Opitz G/BBB syndrome, and DiGeorge syndrome. 6 Presenting clinical symptoms include coughing, cyanosis, aspiration, and choking events, as were noted with our patient. Because neonates often show suck, swallow, and breathing incoordination, 7 the diagnosis of LC is often missed or delayed.…”

Swallowing Analyses of Neonates and Infants in Breastfeeding and Bottle-feeding: Impact on Videofluoroscopy Swallow Studies

“…There is a vast bibliography on the benefits of flow control in the prevention of swallowing problems by reducing the flow, limiting the exit with slow flow holes, and/or thickening the liquid. 35 36 37 38 39 Given that, it can be concluded that in the translactation technique with urethral catheter number 6 or even 8, the flow is tightly controlled, even with the supposed increase in flow due to the ejection of mother's milk in a normal process of breastfeeding.…”

Diagnosis and management of type 1 laryngeal cleft: systematic review

“…Additionally, genetic syndromes such as Opitz-Friaz syndrome, Pallister-Hall syndrome, DiGeorge syndrome, CHARGE syndrome, and VACTERL association are also known to be frequently associated with laryngeal clefts (33).…”

“…Medical management of associated comorbidities aims to improve disorders that may contribute to the swallowing impairments. On the other hand, feeding therapy involves modification to feed thickness, feeding adjuncts, positional strategies and maneuvers to prevent aspiration (6,15,19,22,33). In a research survey by Yeung et al (1), the majority of clinicians recommended anti-reflux therapy only in the presence of laryngopharyngeal reflux symptoms.…”

“…One hundred and three patients who underwent conservative therapy have been identified from seven relevant studies, 20 of whom were asymptomatic and had type 1 LC diagnosed incidentally while undergoing endoscopy for other reasons (15,19,22,23,27,33,39). Fiftytwo point three percent (95% CI, 32.3-71.9%) experienced spontaneous symptom resolution, obtaining a normal diet for age, with conservative management.…”