RESUMEN
OBJECTIVES: Laryngeal Cleft (LC) is an anatomical defect that can cause swallowing difficulties and subsequent recurrent respiratory symptoms. LC can be treated surgically by performing suture repair or by Injection Laryngoplasty (IL). The indications and efficacy of IL are debated among pediatric otolaryngologists. The aim of this survey study was to review the international perspective on IL for LC. METHODS: An online survey was conducted to assess international opinions on the indications and efficacy of IL for LC patients. An online survey was sent to 250 pediatric otolaryngologists worldwide. The survey included questions on the management of LC, the physicians' experience with IL, and their use of IL. RESULTS: Sixty two (25 %) pediatric otolaryngologists, from 47 medical centers, completed the survey. Of the respondents, 38 (62 %) perform IL. The most reported indication was as a diagnostic tool. For the respondents who did not perform IL, the reasons most reported were that the effect is temporary and that there is a need for a second surgery after IL. CONCLUSION: According to this survey, the perspectives on the use of IL for LC differ among pediatric otolaryngologists, and there is variation in peri-and postoperative standard of care. The respondents' opinions on IL were partly dependent on the intended outcome of its use, i.e., as a permanent treatment or for other indications.
RESUMEN
PURPOSE: Laryngeal cleft (LC) is an anatomical defect of the larynx, where there is a gap (or cleft) between the arytenoids. Milder types can be treated with injection laryngoplasty (IL), involving injection with a filler, resulting in a decreased depth of the cleft and thereby reducing tracheal penetration or aspiration. The effect, however, is temporary. The aim of this study was to investigate the possible indications and the efficacy of IL for LC. METHODS: Patients who underwent IL for LC between March 2018 and June 2023 were retrospectively evaluated. The following parameters were studied: incidence of LC symptoms and objective swallowing evaluations before and after IL, the duration of possible symptom improvement, complications, and the number of subsequent suture repairs. RESULTS: Eighty-five patients were included. Before IL, 81 (96 %) patients had symptoms of aspiration during feeding, compared to 41 (54 %) patients after IL (p ≤ 0.001). In 42 (49 %) patients, temporary symptom relief occurred, in 22 (26 %) patients symptoms persisted, in 16 (19 %) patients symptoms decreased permanently. Mild complications such as cough and desaturations in the direct postoperative period occurred. CONCLUSION: This study shows a statistically significant decrease in the number of parents/caretakers reporting swallowing symptoms after injection laryngoplasty, and a decrease in the average percentage of parents/caretakers reporting various other symptoms. Based on our results, injection laryngoplasty can be recommended as a diagnostic tool in the treatment of laryngeal cleft. Furthermore, it can be used as bridge therapy (i.e. until patients outgrow their symptoms, or until suture repair).
RESUMEN
A laryngeal cleft is a rare anatomical deformity which is increasingly treated with injection laryngoplasty. Since diagnosis of laryngeal cleft type I is often made between 2 and 5 years of age, this treatment is rarely performed on very young children. In this case, we describe how injection laryngoplasty is performed safely on an 8-week-old child, and we illustrate its added value for the diagnostic process and for temporary symptom relief.