Pulmonary and Radiographic Findings in Pediatric Type 1 Laryngeal Cleft.

Abstract

Laryngeal clefts are congenital malformations that can result in chronic microaspiration and subsequent lung disease. Type 1 laryngeal clefts can result in subtle presentation and whether or not to repair them remains controversial. In this retrospective cohort study, we describe the pulmonary symptoms and radiographic findings in children before and after type 1 laryngeal cleft repair. Twenty-year single institution retrospective cohort study. Retrospective chart review of pediatric patients who underwent type 1 laryngeal cleft endoscopic CO₂-laser repair between August 2003 and August 2022. Data collected included history of respiratory illness, pulmonary symptoms, medications pre-repair, and radiographic findings pre- and post-repair. Pre- and post-repair chest x-ray (CXR) findings were compared. 325 pediatric patients (200 male and 125 female; median age at repair 2.6 years) required surgical repair between 2003 and 2022. Nearly all (99%) patients presented with respiratory symptoms, nearly half (44%) had a history of pneumonia, and 71% were prescribed at least one pulmonary medication. Median age at laryngeal cleft repair was higher in patients with a history of pneumonia (3.0 years, range 0.5-16.4) compared to patients without pneumonia (2.3 years, range 0.3-16.5), p < 0.001. Abnormal CXR findings were common (80%), with atelectasis (56%) and bronchial wall thickening (59%) being most prevalent. Atelectasis and bronchial wall thickening were significantly less frequent in the post-repair CXRs. Pulmonary symptoms and abnormal CXR findings are common in patients with type 1 laryngeal cleft, and those who do not respond properly to medical management should be considered for endoscopic repair.