Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review

Abstract

Laryngeal cleft (LC) is a congenital anomaly of the aerodigestive tract that has gained increased attention in the recent literature. The evaluation, diagnosis and management of the mildest and most controversial form of the disease, termed type 1 laryngeal cleft (LC1), have been repeatedly cited in the context of feeding and swallowing disorders in children (FSD), mostly in North American literature. 1-7 The purpose of this article is to review the current state of the literature on LC1 in the context of managing the child with FSD and provide a summary of current diagnostic and management strategies, as well as ongoing challenges. | EMBRYOLOGYDuring embryological development, the trachea and oesophagus initially share a common lumen, and are later separated by a septum, which is normally fully formed by 35 days gestation. 8 The occurrence of LC is caused by a failure of the posterior cricoid and laryngeal tissues to fuse during development, resulting in a communication between the larynx/trachea and the hypopharynx/ oesophagus. This arrest of fusion can occur at any point between the 5th and 7th weeks of gestation, resulting in varying degrees of clefting. 9,10 The end result is a partial communication between the airway and digestive tract that can cause feeding and swallowing disorders (FSD) and/or airway distress of varying severity.

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

“…Type 1 laryngeal clefts (T1LCs), as classified by Benjamin and Inglis, 1 are posterior interarytenoid clefts located at the level of the vocal cords with a defect in interarytenoid musculature 2,3 . Patients with T1LC most commonly present with symptoms of dysphagia, chronic cough, recurrent respiratory infections, and abnormal findings on swallowing studies including aspiration and penetration 4 . Deep interarytenoid notches (DINs) are a subclassification of T1LCs with shorter interarytenoid height generally with intact interarytenoid musculature.…”

Injection Laryngoplasty for the Treatment of Type 1 Laryngeal Clefts: A Single Institution Experience

“…These patients may present with or without chronic cough, noisy breathing, choking with feeds, recurrent upper respiratory infections, pneumonia, prolonged feeding times, aberrant feeding behavior and failure to thrive. [1][2][3] Genetics may play a role in the occurrence of these issues, however most cases appear to occur in the absence of other risk factors. 2 Type 1 laryngeal clefts, previously less commonly reported as a cause of pediatric aspiration and penetration, have seen an increase in the reported number of cases in recent years.…”

Rapid Progression of Neonatal Respiratory Distress from Laryngeal Cleft Type I: A Case Report

“…In symptomatic cases, early presentation can include feeding problems, choking, chronic coughing, wheezing, cyanotic spells and apnea. While surgery should be considered only for those whose medical treatment failed, the recommended duration and specifics of conservative management have varied greatly in the literature [2,5]. Decisions of how, when, and how long to initiate conservative therapy often depend on the individual clinician.…”

“…Reported ages at the diagnosis of LC type I vary widely. Most studies report a median age of diagnosis at between 12 and 24 months of age [2]. Parsons, et al reported the average age at onset of symptoms as 4.6 months and diagnosis of LC type I was 3 years and 3 months [3].…”

“…LC has been classified according to the distal end of the cleft, which extends to the level of the true vocal cords (type 1), into the cricoid cartilage (type 2), through the cricoid cartilage and into the cervical trachea (type 3), and into the thoracic trachea (type 4). LC types 0 and I may be asymptomatic or show only mild symptoms, so incidence is possibly underestimated [2,3]. Moreover, LC frequently presents clinical symptoms that can be misattributed to more common diseases, so it is often undiagnosed [4].…”