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

• 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
• DOI: 10.1177/0194599814556068
• EISSN: 1097-6817
• ISSN: 0194-5998

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.