Neurologic Evaluation in Children With Laryngeal Cleft

Walker, Ryan; Irace, Alexandria L.; Kenna, Margaret A.; Urion, David K.; Rahbar, Reza

doi:10.1001/jamaoto.2016.4735

Cited by 15 publications

(16 citation statements)

References 20 publications

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“…It has to be noted that yet failure to thrive was present in seven of the children despite jejunostomy, high‐calorie nutrition, and absence of intestinal problems. A recent study found coexisting neuromuscular dysfunction or dyscoordination in patients with LTECs contributing to dysphagia and aspiration 28 . This is in accordance with our findings reporting normal neurological development in less than half of the patients.…”

Section: Discussionsupporting

confidence: 93%

“…The tracheomalacia remains significant after surgery due to the abnormal tracheal wall structure and often-occurring redundancy of the surgically created posterior tracheal wall. 14 28 This is in accordance with our findings reporting normal neurological development in less than half of the patients. Finally, congenital heart defects were reported more often in our cohort.…”

Section: Clinical Course and Outcomesupporting

confidence: 93%

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Comorbidity and long‐term clinical outcome of laryngotracheal clefts types III and IV: Systematic analysis of new cases

Seidl

Kramer

Hoffmann

et al. 2020

Pediatric Pulmonology

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Background Long segment laryngotracheoesophageal clefts (LTECs) are very rare large‐airway malformations. Over the last 40 years mortality rates declined substantially due to improved intensive care and surgical procedures. Nevertheless, long‐term morbidity, comorbidity, and clinical outcomes have rarely been assessed systematically. Methods In this retrospective case series, the clinical presentation, comorbidities, treatment, and clinical outcomes of all children with long‐segment LTEC that were seen at our department in the last 15 years were collected and analyzed systematically. Results Nine children were diagnosed with long segment LTEC (four children with LTEC type III and five patients with LTEC type IV). All children had additional tracheobronchial, gastrointestinal, or cardiac malformations. Tracheostomy for long‐time ventilation and jejunostomy for adequate nutrition was necessary in all cases. During follow‐up one child died from multiorgan failure due to sepsis at the age of 43 days. The clinical course of the other eight children (median follow‐up time 5.2 years) was stable. Relapses of the cleft, recurrent aspirations, and respiratory tract infections led to repeated hospital admissions. Conclusions Long‐segment LTECs are consistently associated with additional malformations, which substantially influence long‐term morbidity. For optimal management, a multidisciplinary approach is essential.

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Section: Discussionsupporting

confidence: 93%

Section: Clinical Course and Outcomesupporting

confidence: 93%

Comorbidity and long‐term clinical outcome of laryngotracheal clefts types III and IV: Systematic analysis of new cases

Seidl

Kramer

Hoffmann

et al. 2020

Pediatric Pulmonology

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“…A selection bias was likely present for those patients undergoing MDL without VFSS because OSA was likely the main indication for the MDL instead of dysphagia. Although patients with neurological disorders or Trisomy 21 have been found to have higher rates of pharyngeal dysphagia that those without these comorbidities, our cohort did not show any significant clustering for any one group . However, the numbers of patients with these comorbidities were small and could have affected the ability to detect a difference.…”

Section: Discussioncontrasting

confidence: 57%

Pediatric dysphagia: Is interarytenoid mucosal height significant?

et al. 2019

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Objectives: The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS).Methods: A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%).Results: There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1-5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%).Conclusion: There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology.

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“…Airway disorders, such as vallecular cyst, laryngomalacia, vocal fold immobility, and laryngotracheoesophageal cleft, can be diagnosed. [24][25][26][27] Tracheoscopy can diagnose tracheomalacia, tracheal stenosis, and tracheoesophageal fistula. 29 Bronchoscopymayassessforbronchomalacia,bronchiectasis,andevidence of chronic aspiration and pneumonias.…”

Section: Endoscopic Evaluationsmentioning

confidence: 99%

Diagnosis and Management of Pediatric Dysphagia

Lawlor

Choi

2020

JAMA Otolaryngol Head Neck Surg

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ppropriate nutritional intake is essential for the rapid growth and development that occurs during infancy and childhood. 1 Feeding and swallowing dysfunction are diagnosed with increasing frequency, especially in children with a history of prematurity, neuromuscular disorders, cardiopulmonary disorders, anatomic anomalies of the upper aerodigestive tract, and gastrointestinal tract disorders. [2][3][4] Early diagnosis and intervention by a multidisciplinary team are essential to the management of swallowing disorders in children. 5 Physiologic Characteristics of SwallowingThe normal swallow is classically divided into 4 phases: the preparatory phase, the oral phase, the pharyngeal phase, and the esophageal phase. The preparatory phase is when food is taken into the oral cavity, moistened with saliva, chewed, and prepared into a bolus using the oral tongue and hard palate. This phase develops at approximately age 6 months. Before age 6 months, the preparatory phase consists of sucking from a nipple. The oral phase is the propulsion of the food bolus into the oropharynx by the oral tongue and the triggering of the swallow reflex. The soft palate elevates to prevent food from regurgitating into the nasopharynx. The pharyngeal phase is the passage of the food bolus through the oropharynx and hypopharynx toward the esophagus via coordinated muscle contraction. The velum approximates the pharyngeal musculature, the larynx elevates and the vocal folds adduct, and the tongue and pharyngeal muscles propel the bolus into the pharynx. 2,5,6 Respiration ceases during the pharyngeal phase; in fact, while eating, the respiratory rate becomes faster and more irregular than during tidal breathing. 7,8 The esophageal phase consists of cricopharyngeus relaxation, allowing the food bolus to enter the esophagus, and coordinated smooth muscle peristalsis passes the bolus into the stomach. 2,9 Development of the suck and swallow begins in utero as early as gestational week 10 or 11. Gestational age 34 to 38 weeks is typically when most children develop efficiency and tolerance of oral feeding. 5,10,11 In infants, all 4 phases are under involuntary reflex control. In children and adults, the preparatory and oral phases are under voluntary control, and the pharyngeal and esophageal phases remain involuntary. 2 A physiologic swallow is the result of the complex integration of more than 30 nerves and muscles and must progress with the child as their anatomy matures. 2 Dysphagia is defined as difficulty swallowing and must be distinguished from behavioral feeding disorders, such as oral aversion. 1 Dysphagia can be further categorized depending on the disordered phase of swallowing. Oral dysphagia can present as absent oral reflexes, immature or absent suck, uncoordinated biting/chewing, and poor handling of the food bolus. Pharyngeal dysphagia can present as laryngeal penetration, when the food bolus enters the laryngeal vestibule; aspiration, when the food enters the airway below the vocal folds; choking, when food obstructs the airway...

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Neurologic Evaluation in Children With Laryngeal Cleft

Cited by 15 publications

References 20 publications

Comorbidity and long‐term clinical outcome of laryngotracheal clefts types III and IV: Systematic analysis of new cases

Comorbidity and long‐term clinical outcome of laryngotracheal clefts types III and IV: Systematic analysis of new cases

Pediatric dysphagia: Is interarytenoid mucosal height significant?

Diagnosis and Management of Pediatric Dysphagia

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