Infants with feeding and swallowing difficulties may have a laryngeal cleft, or a gap between the vocal cords and esophagus, which can cause them to aspirate, or have feeds enter their lungs. Aspiration can lead to pneumonia, chronic bronchitis, and bronchiectasis, which is damage of the smaller airways and lungs. Untreated laryngeal clefts can also cause failure to thrive because the infant is not efficient at feeding and has increased difficulty breathing.
“These patients can have life-threatening events because infants don’t tolerate aspiration well and can go into respiratory distress or even arrest,” Dr. Jaffal said. “Traditionally, patients with a laryngeal cleft were treated by thickening the liquids for feeds. In some cases, we would inject the area with a filler to augment it and make it a bit higher to help prevent aspiration.”
In endoscopic repair of laryngeal cleft, the surgeon uses small instruments to augment the cleft with sutures. This technique provides a longer lasting and a more robust repair of the laryngeal cleft than injections and reduces the need for repeat procedures that may be needed when injections wear off.
“When we do this, we are operating in a very small area,” Jaffal said. “In infants, the size of the voice box is around one centimeter, so we use microscopes and specialized instruments to create an incision that is two-to-three millimeters long and use three or four sutures to close the cleft. The procedure is completed though the mouth, with no cuts from outside.”
Laryngeal clefts cannot be diagnosed by x-ray or swallow studies and require examination by a pediatric otolaryngologist while under anesthesia.
“I want to increase awareness of this condition so that more parents can begin a conversation with their pediatrician about their concerns about difficulty with feeding and more children can receive the treatment they need,” Jaffal said.
For more information about WVU Medicine Children’s, visit WVUKids.com or call 304-598-1111.