What is a laryngeal cleft?

What is laryngeal cleft?

Laryngeal cleft is an incomplete fusion of the tissue between the upper airway or larynx, and the esophagus or feeding tube. This is a congenital disorder, meaning it is present at birth, and the degree of absent tissue or cleft varies. Laryngeal cleft can contribute to poor weight gain and frequent respiratory infections.

Which signs indicate your child might have a laryngeal cleft?

The most common signs of a laryngeal cleft are difficulty feeding, such as coughing with feeds, and a chronic cough lasting longer than four weeks. You may notice your child had multiple respiratory infections or pneumonias. Sometimes stridor is present, especially when sick, which is high-pitched noisy breathing.

How does laryngeal cleft affect swallowing?

It prevents the complete closure of the airway while swallowing, allowing food particles or liquid to pass into the lungs instead of the stomach. This predisposes the lungs to infection and difficulty in swallowing may result in poor weight gain in children.

What is the diagnosis and treatment for laryngeal cleft?

Diagnosing if your child has a laryngeal cleft is best determined by a procedure called direct laryngoscopy and bronchoscopy (DLB) which requires anesthesia. Other studies that evaluate your child’s swallowing will likely also be performed. Treatment includes oral and feeding therapy done with a speech-language pathologist. Sometimes patients will need surgery to repair the laryngeal cleft, which is performed under general anesthesia. 

What are the types of laryngeal cleft?

• Type 1 is a mild defect situated above the vocal cords. This type does not always require surgery, but if needed, surgical options include an endoscopic approach with an injection versus the use of a laser.
• Type 2 is a moderate defect just below the vocal cords. Patients typically have more noticeable symptoms, and this type requires endoscopic surgery.
• Type 3 is a severe defect below the vocal cords, but does not extend into the chest. Patients will have severe symptoms, and this type also requires surgery. This may be repaired endoscopically or through an open incision in the neck.
• Type 4 is a severe defect below the vocal cords and extends into the chest. Patients will have severe symptoms, and this type requires open-neck surgery.

What is the post-procedure care after laryngeal cleft repair?

You can expect your child to stay in the hospital for one night and go home without any activity restrictions. Feeding instructions will be at the discretion of your otolaryngologist and speech-language pathologist.

If you're concerned that your child is suffering from a laryngeal cleft, please contact Texas Children's Otolaryngology Division at 832-822-2778.

Have you read these blogs?

• Our tracheostomy rounds team 
• Otolaryngology at Texas Children's Hospital
• Does your child have noisy breathing?