Laryngeal Cleft

Overview

Every child has a breathing tube starting at the nose and mouth, which extends into the lungs. He or she also has a feeding tube just behind the breathing tube that brings food and liquid to the stomach. If there is a connection at the very top of these two tubes, we call this a laryngeal cleft.

Diagnosis and Treatment

Laryngeal clefts begin at the very top of the two tubes. Imagine a zipper unzipping; if the zipper unzips only to the level of the vocal cords, then it is labeled a type 1 cleft, and if the zipper unzips all the way down into the chest, it is a type 4 cleft.

Management of a type 1 cleft is usually conservative with anti-reflux medications and feeding modifications. There are also options for a temporary surgical procedure with injection of a slowly dissolving material that may help the child overcome their symptoms until their swallowing improves. Otherwise, a surgical procedure using the microscope or endoscope can be performed to close the cleft. This same procedure can be used for type 2 clefts. All type 3 and 4 clefts require surgical repair and this is generally done through an open approach.