Endoscopic Repair of Type 1 Laryngeal Clefts and Deep Interarytenoid Notches: Cold Steel Versus Laser

Abstract

Objectives/Hypothesis Endoscopic repair is the preferred surgical treatment for type 1 laryngeal clefts (T1LCs) and deep interarytenoid notches (DINs). No studies exist showing differences in repair rates using laser and cold steel. Our objective is to assess overall success and revision rate for endoscopic cleft repair and determine whether there is any difference in surgical outcomes between cold steel and laser techniques. Study Design Retrospective chart review, cohort study. Methods Retrospective review at a quaternary care pediatric hospital. Included all patients who underwent endoscopic repair for T1LCs and DINs between January 2010 and December 2019. Demographics, comorbidities, surgical data, outcomes, and revision status were collected and analyzed. We excluded patients who did not have a follow‐up at our institution. Results A total of 194 patients were identified, 14 were excluded for lack of follow‐up data so 180 were analyzed. Of these, 127 had cold steel repair and 53 had laser repair. There is no significant difference in demographics or comorbidities. In the cold steel group, 4 of 127 (3.1%) had breakdown and in the laser group, 10 of 53 (18.9%) had breakdown. Patients who failed after a cold steel repair tended to break down later (median 12.7 months) when compared to laser repairs (median 2.1 months). Nine of the 10 patients with breakdown after laser repair were noted on initial postoperative evaluation. Conclusions Endoscopic cleft repair is a well‐described and effective method for repair of T1LCs and DINs. Both cold steel and laser have high success rates; however, higher failure rates were noted in the laser repair group. Failure after laser repair may occur earlier than failure after cold steel repair. But this did not reach significance. Level of Evidence 3 Laryngoscope, 131:2805–2810, 2021

Does the History of Tracheoesophageal Fistula Repair Alter Outcomes of Laryngeal Cleft Repair?

“…The small number of those requiring revision in the LC + TEA group may have limited our power to test for significant differences in this subgroup. We noted this outcome in a previous study 12 …”

“…We noted this outcome in a previous study. 12 Beside TEA, the other factors that were investigated as a possible risk for LC repair breakdowns included age at the time of the repair, type of surgery (endoscopic vs open), and cleft type. While endoscopic repairs were associated with greater revision in univariable regression, none of the other factors showed statistically significant associations in multivariable regression, except the type of the cleft itself.…”

Triological Society Best Practice: Repair of Type 1 Laryngeal Cleft

“…The interarytenoid mucosa is denuded with a carbon dioxide (CO2) laser or cold steel instruments and then sutures are placed to increase the interarytenoid height. [1][2][3] ER should be proceeded by a period of conservative management or IIA that demonstrates improvement in symptoms. However, in patients with severe symptoms such as the need for nil per os diet and alternative means of nutrition or severe recurrent respiratory infections, ER may be the initial management approach.…”

“…Thus, in this cohort, the CO2 laser group demonstrated a higher rate of reoperation. 2 By far the most common poor outcomes for IIA is failure to improve symptoms and the safety of swallowing or the need for additional procedures. Allergic reaction to the injectate has been reported.…”

“…T1LC may present in infancy or childhood with dysphagia, aspiration, recurrent respiratory infections, or chronic cough. When sequalae are present, there is significant debate in the literature on diagnosis and the ideal approach to treatment, including conservative management, interarytenoid injection augmentation (IIA), and endoscopic repair with suture closure (ER) 1,2 …”