ASPO047 - Outcomes of Management of Laryngeal Cleft
Saturday, April 30, 2022
4:00 PM – 5:00 PM CT
Location: Landmark B
Amber D. Shaffer, PhD, Katherine E. White, MA, CCC-SLP, Jennifer L. McCoy, MA, Kristin L. Cangilla, MS, CCC-SLP, Kathryn A. Williams, CRNP, Reema Padia, MD, Allison B. J. Tobey, MD
Otolaryngology, UPMC Children's Hosp. of Pittsburgh, PITTSBURGH, PA.
Research Manager UPMC Children's Hospital of Pittsburgh
Introduction: The present aim was to determine whether injection laryngoplasty (IL) for laryngeal cleft (LC) improves swallowing and subjective aerodigestive symptoms 1 and 4 months post-operatively.
Methods: A case series was completed of children, ages 0-17 years, scheduled for IL from August 2015-March 2020 at a tertiary care children’s hospital. Patients were excluded if the cleft extended into the cricoid cartilage. Subjective symptoms were inventoried prospectively based on parental interview and/or provider observations supplemented by chart review. Medical history, intraoperative observations, and swallow evaluations were obtained from the electronic medical record. Statistical analyses included McNemar’s test and logistic regression.
Results: Participation was offered to 90 families; 86 enrolled (35, 40.7% female). Median age at direct laryngoscopy and bronchoscopy for suspicion of laryngeal cleft was 1.5y (range 2m-7y). Coughing or choking with feeding (53, 61.6%), chronic cough (40, 46.5%), and stridor (33, 38.4%) were common presenting symptoms. The most prevalent comorbidities were reflux (44, 51.2%) and prematurity (23, 26.7%). Pre-operatively, aspiration and penetration were observed in 67.6% and 48.7% children, respectively. Obstructive adenoids (36, 41.9%), laryngomalacia (LM; 27, 31.4%), and submucous cleft palate (26, 30.2%) were common concomitant airway anomalies. The LC reached the true vocal folds in 38 (55.1%; type 1). Injection was completed in 62 (72.1%). Overall, stridor, coughing/choking with feeds, and aspiration were less common 1m and 4m post-operatively compared with pre-operatively (p < 0.05 for all). At 1m, aspiration was less common in both the non-LC (OR: 0.111, 95 % CI: 0.002-0.802, P=0.02) and type I (OR: 0.200, 95% CI: 0.021-0.939, P=0.04) groups compared with pre-operatively. Concomitant supraglottoplasty (SGP), but not IL or LC type, significantly decreased the odds of advancement to thinner liquids at 4m (OR: 0.555, 95% CI: 0.017-0.971, P=0.03).
Conclusion: IL may allow for additional developmental maturation of swallowing as the injection material resorbs. Children may experience long-term improvement in swallowing safety, even if they do not meet the anatomic definition of LC. Severe LM requiring SGP may alter the benefits of IL.