Laryngeal cleft repair – formal suture technique

Abstract

Laryngeal clefts are congenital anomalies characterized by an abnormal connection between the upper airway and esophagus due to incomplete fusion of the tracheaesophageal septum. These clefts can be mild, with just a deficiency of soft tissue in the interarytenoid space (Type 1) or can extend down into the cartilage of the cricoid (Type 2) as well as into the trachea (Type 3, 4). Presentation of laryngeal clefts is most often characterized by aspiration of thin liquids, recurrent respiratory infections, cough, respiratory distress, and cyanotic episodes. The treatment of Type I laryngeal clefts can be conservative, such as with thickening of feeds and medical management or procedural, such as with injection laryngoplasty or endoscopic surgical repair. Endoscopic surgical repair has been utilized to repair these clefts for several decades, and more recently is being utilized to repair deeper clefts that were previously repaired via an open approach. In this article we will describe the background and indications for repair of laryngeal clefts, and the details of the endoscopic suturing technique. Laryngeal clefts are congenital anomalies characterized by an abnormal connection between the upper airway and esophagus due to incomplete fusion of the tracheaesophageal septum. These clefts can be mild, with just a deficiency of soft tissue in the interarytenoid space (Type 1) or can extend down into the cartilage of the cricoid (Type 2) as well as into the trachea (Type 3, 4). Presentation of laryngeal clefts is most often characterized by aspiration of thin liquids, recurrent respiratory infections, cough, respiratory distress, and cyanotic episodes. The treatment of Type I laryngeal clefts can be conservative, such as with thickening of feeds and medical management or procedural, such as with injection laryngoplasty or endoscopic surgical repair. Endoscopic surgical repair has been utilized to repair these clefts for several decades, and more recently is being utilized to repair deeper clefts that were previously repaired via an open approach. In this article we will describe the background and indications for repair of laryngeal clefts, and the details of the endoscopic suturing technique.