Outcomes and Resource Utilization of Endoscopic Mass‐Closure Technique for Laryngeal Clefts

Abstract

Objectives: (1) Describe operative time and materials for a mass-closure endoscopic laryngeal cleft repair technique. (2) Determine swallowing and endoscopic outcomes of this technique. Methods: Case series of children with confirmed diagnosis of type 1, 2, and 3 laryngeal clefts from 2008 to 2013 in a tertiary pediatric aerodigestive program. Interventions: Endoscopic mass cleft closure; pre- and postoperative swallow evaluations. Outcomes: Operative time, number of sutures, laser use, endoscopic findings, aspiration or penetration on postoperative swallow evaluation. Results: Eighteen patients were studied. Mean age 5.8 ± 4.9 years (range, 0.3-7 years). Sixteen had type I cleft, 1 had type II, and 1 had type III. Four had unilateral or bilateral vocal fold immobility preoperatively. Fifteen underwent functional endoscopic evaluation of swallow (FEES) and/or videofluoroscopic swallow study (VSS) preoperatively; 14 showed laryngeal penetration and/or aspiration. Mean operating time was 76.6 ± 40.9 minutes (range, 43-181 minutes) with a fellow or resident participating in all cases. Operating time was unchanged by laser use ( P = .15) or presence of tracheostomy ( P = .34). Mean 2.5 ± 0.6 sutures were required for each repair (range, 2-4). Twelve patients spent 1 postoperative night in hospital. Mean follow-up was 87.7 ± 15.8 months (range, 1 week-61.2 months). Sixteen patients have had postoperative endoscopy to date; intact repair was noted in all 16. Postoperative VSS was available for 8 patients and demonstrated persistent aspiration in 2 patients, with further improvement expected in 1 as sensation returned. No operative complications occurred. Conclusions: The endoscopic mass-closure technique is safe, fast, technically straightforward, and produces swallowing outcomes similar to traditional techniques. Postoperative hospital stay is brief, and repairs remain intact over long-term follow-up.