Management of Symptomatic Grade I and II Laryngeal Cleft: Experience of a Tertiary Care Center and Review of Literature
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Management of Symptomatic Grade I and II Laryngeal Cleft: Experience of a Tertiary Care Center and Review of Literature Anindya Nayak1 • Preetam Chappity1 Karakkandy Vinusree1
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Sidharth Pradhan1 • Pradeep Pradhan1 • Pradipta Parida1
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Received: 16 July 2020 / Accepted: 23 September 2020 Association of Otolaryngologists of India 2020
Abstract Laryngeal cleft is a rare pathology and needs a high index of suspicion for diagnosis. Various classifications are used but the Inglis classification which describes 4 grades of cleft is most widely accepted. Grade 3 and 4 clefts are very rare and are usually associated with other congenital abnormalities. Grade 1 and 2 clefts are more common and can be easily corrected with good outcomes. We are presenting our experience with 9 cases of low grade (Grade 1 and 2) laryngeal cleft which were managed successfully in our department. Out of the 9 cases 4 failed conservative management and required a trans-oral repair. All patients improved with management, except one who intermittently developed another episode of pneumonia 2 months’ post-surgery. However satisfactory cleft obliteration was confirmed on endoscopy and the patient has been under close follow up ever since. Majority of low grade laryngeal clefts can be managed with dietary modifications and feeding rehabilitation. Those who do not respond usually require surgical repair with near complete resolution of symptoms. Keywords Laryngeal Cleft Conservative Endoscopy
& Preetam Chappity [email protected] 1
Department of ENT, All India Institute of Medical Sciences Bhubaneswar, Room No 175, Sijua, Patrapada, Bhubaneswar, Odisha, India
Introduction Laryngeal clefts are rare congenital anomalies of the aerodigestive tract because of a deficient anatomical separation of the oesophagus and respiratory system at the level of the larynx and trachea. Incidence is reported as 1 in 10,000 to 1 in 20,000 live births, more common in boys than girls with a ratio of 5:3 [1, 2]. Depending on the extent of the cleft in the larynx and trachea, life-threatening disturbances of respiration can occur immediately after birth. The condition was first described by Richter [3] in a new-born who presented with aspiration. It was Petterson [4] who attempted the first surgical reconstruction and also proposed a classification in 1955. Over the years, multiple classifications have been described with the one described by Benjamin and Inglis [5] being most widely used today. Numerous theories [6] that have been proposed to explain the development of tracheoesophageal anomalies. They can be divided into due to intraembryonic pressure by heart and the curvature of esophagus, epithelial occlusion defect in esophagus, vascular occlusion due to persistent aberrant vessel causing low perfusion of the gut and differential cell growth. Embryologically, a posterior laryngeal cleft is due to the incomplete formation of the interarytenoid membrane which may also include the absence of interarytenid muscle [7]. The classification pro
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