Postoperative Observation of Children after Endoscopic Type 1 Posterior Laryngeal Cleft Repair

Objectives To report the perioperative management and surgical outcomes in a large series of pediatric patients with endoscopically repaired type 1 posterior laryngeal cleft (PLC). Study Design Case series with chart review. Setting Urban, tertiary care, free-standing pediatric hospital. Subjects an...

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Bibliographic Details
Published in:	Otolaryngology-head and neck surgery Vol. 152; no. 1; pp. 153 - 158
Main Authors:	Alexander, Nathan S., Liu, Judy Z., Bhushan, Bharat, Holinger, Lauren D., Schroeder, James W.
Format:	Journal Article
Language:	English
Published:	Los Angeles, CA SAGE Publications 01-01-2015
Subjects:	aspiration Child, Preschool Congenital Abnormalities - classification Congenital Abnormalities - surgery dysphagia Female Humans Infant Laryngoscopy - methods Larynx - abnormalities Larynx - surgery Lasers, Gas - therapeutic use Male posterior laryngeal cleft Postoperative Care Retrospective Studies dysphagia posterior laryngeal cleft aspiration
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Summary:	Objectives To report the perioperative management and surgical outcomes in a large series of pediatric patients with endoscopically repaired type 1 posterior laryngeal cleft (PLC). Study Design Case series with chart review. Setting Urban, tertiary care, free-standing pediatric hospital. Subjects and Methods Patients who underwent endoscopic carbon dioxide laser–assisted repair of type 1 posterior laryngeal clefts between January 2006 and December 2012. Medical records were reviewed. Results Fifty-four patients (34 male) underwent repair of type 1 PLC. Median age was 25.5 months (range, 2-120 months). Indications for repair included aspiration (n = 39; 72%), chronic bronchitis (n = 13; 24%), and stridor with feeds (n = 2; 4%). No children remained intubated postoperatively. Thirty-three patients (61%) stayed in overnight observation (“Obs PLC”) and 21 patients (39%) stayed in the pediatric intensive care unit (“PICU PLC”) postoperatively. Between Obs PLC and PICU PLC groups, there was no significant difference in age (mean 22 vs 30 months, respectively; P = .28). Comorbidities were similar between the groups. Symptoms improved in 41 of the 54 patients (76%). No postoperative complications were noted. Two patients required revision PLC repair. The cost of admitting a patient to a lower acuity location was estimated to be 60% less per day than cost of a PICU admission. Conclusions The endoscopic surgical repair of a type 1 PLC is successful and has a low morbidity and complication rate. Patients may be safely managed in an observation unit and without postoperative intubation. This approach achieved a marked cost reduction in postoperative care.
Bibliography:	No sponsorships or competing interests have been disclosed for this article. This study was presented as a poster at the American Society of Pediatric Otolaryngology spring meeting; May 16, 2014; Las Vegas, Nevada. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0194-5998 1097-6817
DOI:	10.1177/0194599814556068