Outcomes and swallowing evaluations after injection laryngoplasty for type I laryngeal cleft: Does age matter?

Cole, Elisabeth B.; Dreyzin, Alexandra; Shaffer, Amber D.; Tobey, Allison B.J.; David, Helena Maria Scherlowski Leal; Tarchichi, Tony

doi:10.1016/j.ijporl.2018.09.006

Cited by 16 publications

(20 citation statements)

References 20 publications

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“…30 IL is also considered generally faster and easier to perform and carries less risk than endoscopic surgical closure. 27 As evidenced by our data, IL resulted in almost no complications, with only 1 study reporting postinjection laryngeal swelling. With regard to ease of performance, few of the studies documented operative times.…”

Section: Discussionsupporting

confidence: 53%

“…Of the 21 endoscopic studies, 8 quantified the mean time elapsed between diagnosis and intervention (median, 7.3 months; range, 0.85-19.4 months). 2,4,8,11,14,27,31,37 Of the injection studies, 2 included the time from diagnosis to injection (means, 1 and 2 months), 27,37 while the others injected at the time of diagnosis or did not mention it. Finally, 4 studies employed conservative therapy before intervention, stating that the therapy was for one, 26 two, 1 six, 4 and four to eight 38 months before any operative intervention.…”

Section: Resultsmentioning

confidence: 99%

“…After the titles and abstracts were screened, 64 full-text articles were reviewed. After final review, 27 articles [1][2][3][4]8,[11][12][13][14]17,18,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were included for qualitative and quantitative analysis ( Figure 1). Of the 27 included studies, 19 were from the United States; 1 each from Saudi Arabia, Japan, Australia, Canada, and Ireland; and 3 from the United Kingdom.…”

Section: Literature Search and Risk-of-bias Assessmentmentioning

confidence: 99%

“…12 Leonardis et al, who performed robot-assisted blunt dissection with suture closure, described a mean operative time of 137.6 minutes, with a range of 105 to 173 minutes. 33 IL was used in 9 studies, of which 6 (66.6%) used carboxymethylcellulose gel mixed with sodium, 1,8,28,37 glycerin, 27 or calcium hydroxyapatite. 35 Gelfoam was the only injection material for 2 studies 29,30 and for some of the patients in 2 others.…”

Section: Literature Search and Risk-of-bias Assessmentmentioning

confidence: 99%

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Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta‐analysis

Timashpolsky

Schild

Ballard

et al. 2020

Otolaryngol.--head neck surg.

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Objective Endoscopic surgical management or injection laryngoplasty of type 1 laryngeal clefts in pediatric patients is used in those who do not respond to conservative treatment. This study compares conservative treatment, endoscopic surgical repair, and injection laryngoplasty for the management of type 1 laryngeal clefts. Data Sources PubMed, Web of Science, and Embase. Review Methods This systematic review included studies of patients with type 1 laryngeal clefts who were managed with conservative treatment, injection laryngoplasty, or endoscopic repair, and all studies reported postintervention outcomes. Two independent investigators assessed study eligibility, rated the quality, and extracted data for analysis. A random effects model was used for meta-analysis of pooled data. Results Of the 1209 studies identified, 27 met inclusion criteria. There were 543 patients with type 1 laryngeal clefts represented in the studies, with outcomes reported for 537. Conservative therapy had a 52% (95% CI, 37%-66%; I2 = 63%) success rate at improving symptoms, while endoscopic repair had a significantly higher percentage resolution of symptoms (70%; 95% CI, 59%-79%; I2 = 62%, P < .001) as compared with conservative treatment (51%; 95% CI, 36%-65%; I2 = 62%) or injection laryngoplasty (36%; 95% CI, 20%-57%; I2 = 70%). The quality scores of the studies ranged from 7 to 12 out of 16. Conclusion Our systematic review demonstrated significant improvement and resolution of symptoms for patients with type 1 laryngeal clefts treated with endoscopic repair as compared with other modalities. More prospective and controlled studies comparing treatment strategies with validated instruments to measure outcomes are necessary to determine their efficacy in the management of type 1 laryngeal clefts.

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Section: Discussionsupporting

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Section: Literature Search and Risk-of-bias Assessmentmentioning

confidence: 99%

Section: Literature Search and Risk-of-bias Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta‐analysis

Timashpolsky

Schild

Ballard

et al. 2020

Otolaryngol.--head neck surg.

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“…Age at time of injection did not appear to significantly affect the utility of IAIA in improving PAS scores, clinical findings, or advancement in diet. This is in accordance with a study by Cole et al indicating that an age of less than 1 year versus older than 1 year does not appear to change the efficacy of IAIA 20 . Preterm patients are thought to have higher rates of dysphagia compared to their full‐term counterparts 21, 22 .…”

Section: Discussionsupporting

confidence: 91%

Predictive Utility of the Penetration‐Aspiration Scale in Inter‐Arytenoid Injection Augmentation

et al. 2020

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Objectives/Hypothesis To determine the utility of preoperative penetration‐aspiration scale (PAS) scores and clinical findings on modified barium swallow (MBS) in predicting advancement of diet after interarytenoid injection augmentation (IAIA). Study Design Retrospective review. Methods In this retrospective cohort study, 372 consecutive patients who underwent IAIA for pharyngeal dysphagia between 2009 and 2019 were initially identified. Patients were excluded from the study if they had insufficient preop MBS, no postop MBS within 3 months of injection, supraglottoplasty, or underlying neurological condition. Ninety‐three patients were included in the study. Pre‐ and postoperative PAS scores were recorded, as were pre and postop diets. PAS scores were calculated by a single pediatric speech and language pathologist. Results Average PAS score on MBS was 5.87 (standard deviation [SD] 2.74); median (range) = 8 (1–8). Postop average was 4.29 (SD 3.02); median (range) = 2 (1–8), P < .001. Those with worse preop PAS scores had increased odds of improvement in diet (odds ratio 1.24, 95% confidence interval [CI] 1.02–1.49, P = .029). An improvement in PAS score of 3.0 or greater predicted an improvement in diet with a sensitivity of 76.7% and a specificity of 85.7%. Conclusions PAS score on MBS can be a useful tool when assessing pediatric patients who may be candidates for IAIA. Prospectively comparing PAS score in patients post‐IAIA to patients solely undergoing diet modification can help to better objectively assess differences in outcomes and understand the full utility of PAS score. Level of Evidence Level III (Individual Cohort Study) Laryngoscope, 131:E1707–E1713, 2021

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Surgical Treatment of Type III Laryngotracheoesophageal Clefts: Techniques and Outcomes

et al. 2021

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Objectives/Hypothesis Determine surgical and swallowing outcomes after surgery for type III laryngotracheoesophageal cleft (LTEC). Study Design Case series with chart review. Methods Chart review was performed on patients with type III LTEC between 2000 and 2019. Demographics, surgical outcomes, and swallowing outcomes were collected and analyzed. Results Thirty‐three patients met inclusion criteria (28 open and 5 endoscopic repairs). Mean age was 3.4 years for the open group and 0.9 years for the endoscopic group. Seventeen (51.5%) patients had a syndromic diagnosis, most commonly Opitz syndrome and Trisomy 21. Mean follow‐up was 33.6 months. Thirteen (39.4%) patients had a previous repair attempt prior to repair at our institution. Twenty‐four (70.6%) patients had a tracheostomy prior to or at the time of surgical repair and 13 (38.2%) remain tracheostomy‐dependent. Nine patients (27.3%) required a revision cleft repair and four (12.1%) required two revisions. Thirty‐one patients had an intact repair at last follow‐up (93.9). Two patients died outside the hospital over a year after surgery. Preoperatively 13 of 17 patients with swallowing evaluations aspirated. After repair, 11 of 20 patients were deemed safe for all consistencies and seven were safe for thickened. Endoscopic approaches were performed during the last 2 years of the study and had significantly lower operative time (354.4 minutes vs. 171.5 minutes). Conclusions Endoscopic and open approaches are effective for treatment of type III LTEC with 27.3% requiring revision and 93.9% of repairs intact at last follow‐up. Overall swallowing outcomes were good in patients who underwent postoperative instrumental swallow evaluation. Level of Evidence 4 Laryngoscope, 132:1112–1117, 2022

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Outcomes and swallowing evaluations after injection laryngoplasty for type I laryngeal cleft: Does age matter?

Cited by 16 publications

References 20 publications

Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta‐analysis

Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta‐analysis

Predictive Utility of the Penetration‐Aspiration Scale in Inter‐Arytenoid Injection Augmentation

Surgical Treatment of Type III Laryngotracheoesophageal Clefts: Techniques and Outcomes

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