Diagnosis and Management of Type I Posterior Laryngeal Clefts

作者：Bakthavachalam Sivi; Schroeder James W Jr^*; Holinger Lauren D

来源：Annals of Otology Rhinology and Laryngology, 2010, 119(4): 239-248.

• aspiration dysphagia
• pediatric airway
• posterior laryngeal cleft

Objectives: We review the diagnosis and management of type I posterior laryngeal clefts (PLCs)
Methods: We performed a retrospective study at tertiary-care children's hospital of children who were diagnosed with a PLC between January 2003 and August 2008 We studied concurrent airway anomalies. comorbidities. presenting symptoms, age at the time of aspiration resolution. and rate of aspiration resolution
Results: Sixty-seven children with PLCs were identified (41 boys and 26 girls) Filly-nine had type I clefts. 6 had type II and 2 had type III. Of the 59 type I cases. 15 (25 4%) were surgically repaired by endoscopy Eleven of these 15 children (73 3%) have had symptomatic improvement since the surgery. and 7 of those 11 (63 6%) ale tolerating thin liquids by mouth Two of the 15 (133%) displayed no improvement with still:cry. and 2 of the 15 (13 3%) were lost to follow-up Forty-four of the 59 type 1 clefts (74 6%) were managed nonsurgically Twenty of these 44 children (45 5%) did not present with aspiration Twenty-four of the 44 (54 5%) presented with aspiration. and 16 of the 24 (66 7%) are now tolerating thin liquids by mouth Seven of these 24 patients (29 2%) are still aspirating. and I has died The average time to resolution of aspiration was 7 8 months tor the surgical group and 13 6 months for the nonsurgical group (p = 0 19). In the surgical group. the average age at resolution of aspiration for patients who received their diagnosis at 0 to 6 months of age was 21 5 months, that for those with a diagnosis at 6 (012 months was 27 3 months, and that for those with a diagnosis at older than 12 months was 27 3 months (p = 0 31) In the nonsurgical group, the average age at resolution of aspiration for patients who received their diagnosis at 0 to 12 months of age was 15 8 months, that for those with a diagnosis at 12 to 24 months was 273 months, and that for those with a diagnosis at older than 24 months was 773 months (p = 0 0015)
Conclusions: We found that I) the reported incidence of type 1 PLCs is increasing. 2) type 1 PLCs can often present without clinical aspiration, 3) aspiration caused by type I PLCS can be managed medically or surgically, and 4) operative in is advantageous for patients who have severe symptoms in who have persistent aspiration abet 2 years of age

• 出版日期2010-4
• 单位西北大学