Endoscopic surgical treatment of laryngotracheal clefts: indications and limitations.

OBJECTIVE To present the indications, techniques, results, and limitations of endoscopic surgical treatment of laryngotracheal cleft. DESIGN Retrospective case note study (2005-2009). SETTING Department of Otolaryngology-Head and Neck Surgery, Armand Trousseau Children's Hospital, Paris, France. PATIENTS Eleven patients who underwent endoscopic cleft closure as a primary (n = 8) or secondary (n = 3) procedure among 22 patients treated for laryngotracheal clefts. We report patients' demographics, symptoms leading to the diagnosis, endoscopic evaluation method, medical examination results, and surgical techniques. INTERVENTION Endoscopic closure of the cleft under spontaneous ventilation via 2-layer interrupted sutures after excision of the mucosal edge using a carbon dioxide laser in 10 patients and a thulium laser in 1. MAIN OUTCOME MEASURES Analysis of postoperative complications, revision surgery, need for intensive care unit admission, closure of the cleft, and long-term symptom results. RESULTS Successful closure of the 11 clefts (with revision surgery in 3 patients) without the need for intubation or intensive care unit admission enabled the elimination of aspiration in 10 patients and significant improvement in 1 patient with bilateral vocal cord paralysis. There were no significant postoperative complications. CONCLUSIONS Endoscopic closure of laryngotracheal clefts is a reliable technique that significantly reduces perioperative and postoperative morbidity. The results of this technique are entirely satisfactory, and we suggest that it is suitable as a primary procedure for the treatment of type I, II, and III clefts extending to the cervical trachea, including in neonates.