Benjamin-Inglis classification of laryngotracheal cleft: adapted from Benjamin & Inglis, Ann Otol Rhinol Laryngol 1989.

A laryngotracheal cleft is a rare congenital defect in which there is a defect in the separation between the upper airway (larynx and possibly trachea) and the esophagus or swallowing tube. In children with a laryngotracheal cleft, the tissue that divides the larynx and trachea from the esophagus is underdeveloped. This gap can lead to varying degrees of swallowing dysfunction. Children with a laryngotracheal cleft can inhale liquids, foods, salivary and/or gastric secretions into the lungs. This situation if untreated can leave a child at risk for recurrent respiratory illnesses and lung injury.

Symptoms

Symptoms include feeding difficulties, feeding aversions, failure to thrive, chronic cough, recurrent respiratory illnesses, pneumonia, respiratory distress and/or noisy breathing.

Diagnosis

Often a radiographic study of swallowing dynamics may be used to establish whether your child is aspirating liquids. The back of the larynx is visually inspected and gently palpated with an angled instrument. If a cleft is confirmed,  Dr. Kopelovich will then determine the severity of your child’s defect and will discuss the treatment options.

Treatment

• Milder forms of laryngotracheal clefts can be repaired endoscopically.
• Both temporary and permanent treatments exist.
• Temporary treatment may be performed at the time of diagnosis and consists of endoscopic injection of a resorbable filler into the laryngotracheal cleft.
• If your child improves in swallowing temporarily and then regresses after 3 to 6 months, he or she may be appropriate for a more permanent repair.

What should we expect after laryngotracheal cleft repair?

• Your child may have an irritated or sore throat for 1-2 days following the procedure. Cool fluids may provide comfort.
• Your child will usually be observed in the hospital and possibly the Intensive Care Unit overnight.
• There may be an increase in noisy breathing. This should improve.
• Dietary restrictions in place before the procedure are generally maintained until a post-operative swallowing evaluation has been performed with a licensed feeding therapist.

What are some reasons we should contact our doctor after surgery?

• Minor throat irritation is common after airway evaluation. Contact your physician if your child has a persistent cough lasting more than 3 days, pain not relieved with Tylenol or Motrin, or any worsening in noisy breathing and/or work of breathing.