Shilpa Ojha1, Jean E Ashland2, Cheryl Hersh3, Jyoti Ramakrishna4, Rie Maurer1, Christopher J Hartnick5. 1. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston. 2. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts3Department of Gastroenterology, Massachusetts General Hospital, Boston. 3. Department of Pediatrics, Massachusetts General Hospital, Boston 5Pediatric Airway, Voice, and Swallowing Center, Massachusetts Eye and Ear Infirmary, Boston. 4. Department of Speech-Language and Swallowing Disorders, Massachusetts General Hospital, Boston7Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston. 5. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
Abstract
IMPORTANCE: Early diagnosis and assessment in children with type 1 laryngeal cleft are essential in preventing aspiration and associated comorbidity. Appropriate use of conservative and surgical interventions in an evidence-based management strategy can improve overall outcome. OBJECTIVE: To evaluate the management of care for children with type 1 laryngeal cleft in our practice and develop an updated management algorithm. DESIGN, SETTING, AND PARTICIPANTS: We performed a review of medical records at a tertiary pediatric aerodigestive center. During a period of 7 years (July 18, 2005, to July 18, 2012), 1014 children younger than 18 years were evaluated for aspiration, choking, cough, or recurrent pneumonia. Of these, 44 children (4.3%) had a type 1 laryngeal cleft. Two were lost to follow-up; thus, 42 children were included in our final sample (28 males, 14 females). INTERVENTIONS: The care of 15 patients (36%) was managed conservatively, and 27 patients (64%) underwent endoscopic surgical repair of their laryngeal cleft. MAIN OUTCOME AND MEASURE: Assessment of our current management strategy. RESULTS: Success was defined as improving when a child was able to tolerate a feeding without aspirating or resolved when the child had transitioned to tolerating thin liquids. All patients received a trial of conservative therapy. Fifteen of the 42 patients (36%) had an anatomic cleft and were able to maintain the feeding regimen; thus, conservative treatment was successful in this group. The remaining 27 patients (64%) received surgical intervention. Overall operative success rate was 21 of the 27 patients (78%). The age of the child (P < .01) and comorbid conditions (P < .001) affected the outcomes of conservative measures and surgical repair. Only 6 patients did not demonstrate resolution, 5 of whom had significant comorbidities. CONCLUSIONS AND RELEVANCE: Age, comorbidity status, severity of aspiration, and the ability to tolerate a feeding regimen should be taken into account when deciding on conservative or surgical management for children with a type 1 laryngeal cleft. A clinical pathway for conservative and surgical management is presented.
IMPORTANCE: Early diagnosis and assessment in children with type 1 laryngeal cleft are essential in preventing aspiration and associated comorbidity. Appropriate use of conservative and surgical interventions in an evidence-based management strategy can improve overall outcome. OBJECTIVE: To evaluate the management of care for children with type 1 laryngeal cleft in our practice and develop an updated management algorithm. DESIGN, SETTING, AND PARTICIPANTS: We performed a review of medical records at a tertiary pediatric aerodigestive center. During a period of 7 years (July 18, 2005, to July 18, 2012), 1014 children younger than 18 years were evaluated for aspiration, choking, cough, or recurrent pneumonia. Of these, 44 children (4.3%) had a type 1 laryngeal cleft. Two were lost to follow-up; thus, 42 children were included in our final sample (28 males, 14 females). INTERVENTIONS: The care of 15 patients (36%) was managed conservatively, and 27 patients (64%) underwent endoscopic surgical repair of their laryngeal cleft. MAIN OUTCOME AND MEASURE: Assessment of our current management strategy. RESULTS: Success was defined as improving when a child was able to tolerate a feeding without aspirating or resolved when the child had transitioned to tolerating thin liquids. All patients received a trial of conservative therapy. Fifteen of the 42 patients (36%) had an anatomic cleft and were able to maintain the feeding regimen; thus, conservative treatment was successful in this group. The remaining 27 patients (64%) received surgical intervention. Overall operative success rate was 21 of the 27 patients (78%). The age of the child (P < .01) and comorbid conditions (P < .001) affected the outcomes of conservative measures and surgical repair. Only 6 patients did not demonstrate resolution, 5 of whom had significant comorbidities. CONCLUSIONS AND RELEVANCE: Age, comorbidity status, severity of aspiration, and the ability to tolerate a feeding regimen should be taken into account when deciding on conservative or surgical management for children with a type 1 laryngeal cleft. A clinical pathway for conservative and surgical management is presented.
Authors: Ryan D Walker; Alexandria L Irace; Margaret A Kenna; David K Urion; Reza Rahbar Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-07-01 Impact factor: 6.223
Authors: Amar Miglani; Scott Schraff; Pamela Y Clarke; Usmaan Basharat; Peter Woodward; Paul Kang; Lindsay Stevens; Jim Woodward; Howard Williams; Dana I Williams Journal: Curr Gastroenterol Rep Date: 2017-11-06
Authors: Nikolaus E Wolter; Kayla Hernandez; Alexandria L Irace; Kathryn Davidson; Jennifer A Perez; Kara Larson; Reza Rahbar Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-01-01 Impact factor: 6.223