What Is a Laryngeal Cleft (or Laryngotracheoesophageal Cleft)?
There are two tubes in your neck or throat:
- The esophagus, which helps food and liquid pass from your mouth into the stomach
- The trachea (windpipe), which takes oxygen to your lungs as you breathe in
The larynx (voice box) sits at the top of the trachea, right next to the esophagus. The larynx helps keep any food or liquid from getting into the trachea (the airway tube leading to our lungs).
The larynx and the esophagus should not have any type of space or gap between them. When a gap exists, it is known as a laryngeal cleft. With a cleft, food or liquids can go into the airway tube when the child swallows. This causes a number of eating and breathing problems.
Signs and Symptoms
A child with a laryngeal cleft can have a wide range of signs and symptoms such as:
- Excessive coughing
- Choking with feedings
- Shortness of breath
- Poor weight gain
- Hoarseness
- Short pauses when breathing (apnea)
- Noisy breathing (stridor)
- Frequent lower respiratory infections (pneumonia)
- Food and / or liquid going into the lungs (aspiration)
- Gastric esophageal reflux (GERD)
Causes of Laryngeal Cleft
Children are born with a laryngeal cleft. This means it is congenital (present at birth). We do not know what causes a laryngeal cleft to occur. It happens during the early months of pregnancy.
Diagnosing Laryngeal Cleft
A laryngeal cleft is diagnosed with a microlaryngoscopy and bronchoscopy (ML&B). Sometimes the child may need other tests or X-rays to check for aspiration (food / liquid going into the lungs) or other abnormalities.
Types of Laryngeal Cleft
The cleft can vary from mild to severe. This depends on how big the gap is between the esophagus and the airway.
- A type I laryngeal cleft is a gap above the vocal cords. This is the mildest form.
- A type II laryngeal cleft extends below the vocal cords into the lower cartilage of the larynx (voice box).
- A type III laryngeal cleft extends beyond the larynx (voice box) and into the trachea (windpipe).
- A type IV laryngeal cleft extends even further down into the trachea (windpipe). It may go all the way to the bottom of the trachea. This is the most severe form.
Treatment of Laryngeal Cleft
Surgery for this condition is called a laryngeal cleft repair. It is required for patients with types II, III or IV. The repair most often involves opening up the larynx and closing the laryngeal cleft with sutures. Some children, who have few symptoms and minor clefts, do not need surgery. These children are checked often for any changes in their symptoms.
If a child continues with aspiration or breathing concerns, the doctor will discuss what care options or surgeries are best for the child.
When to Get Help:
- Call 911 if your child has problems breathing.
- Call your child’s doctor if your child struggles to swallow their food, coughs or chokes often when eating or is not gaining weight.
