Sunday, December 11, 2011

Laryngeal Cleft

Is a rare abnormality of the separation between the larynx and the esophagus.  When the larynx develops normally it is completely separate from the esophagus, so swallowed foods and liquids go directly into the stomach.  A laryngeal cleft creates an opening between the larynx and the esophagus so food and liquid are in danger of passing through the larynx into the lungs.  They are classified into four types according to length.  Type I extends no further down than the vocal cords, type II extends below the vocal cords and into the crinoid cartilage, type III extends into the cervical section oft he trachea and type IV extends the furthest- into the thoracic section of the trachea. Occurs in less than 0.1 percent of the population. 

Symptoms:  Swallowing problems, coughing, gagging, frequent respiratory infections and chronic lung disease, cyanosis, failure to gain weight overtime, pulmonary infections.

Tests:  Diagnosed through a comprehensive aero-digestive evaluation.  A barium swallow study or FEES swallow study will determine if aspiration on liquids/foods is happening.  It is diagnosed through a endoscopic examination (microlaryngoscopy and bronchoscopy). 

Treatment:  Depends on the length and resulting severity of symptoms.  A type I cleft may not require surgical intervention.  Symptoms can be managed by thickening liquids and foods.  A slightly longer cleft is repaired endoscopically (long type I and short type II).  A cleft that is longer (type II or type III) is repaired directly through the neck with a tracheotomy. 

Resources:  Dr. Cotton (513) 636-4355 at Children's Hospital in Cincinnati
Dr. Rahbar (617) 355-6460 at Children's Hospital of Boston

Online Support Group-

Photo: Marcelle and her little miracle, Aiden

Marcelle's Story:
Our son, Aiden, is 2 years old and has a laryngeal cleft.  He was diagnosed with a type II laryngeal cleft when he was 2 months old.  We first saw symptoms such as choking and having apnea spells with these feeds.  He was admitted to Children's Hospital for a week of testing.  While there Aiden was spiking fevers after his feeds.  After numerous tests and procedures, he had a swallow study that showed aspiration on thin liquids.  He then had a bronchoscopy which showed a type II laryngeal cleft.  His laryngeal cleft was surgically (endoscopically) repaired when he was 6 months old.  Aiden has been in swallow therapy since he was 5 months old.  Despite the repair and swallow therapy he continues to aspirate on thin liquids.  We will continue swallow therapy and repeated swallow studies to ensure he is making improvements in his ability to swallow liquids.


  1. hello. im hoping you may still watch this post as i am in desperate need of some advice. my son has just been diagnosed with subglottic stenosis and a laryngeal cleft. he is going soon to have the dye test. he is 6 months old and always chokes and gags to the point where he is physically sick. he has frequent colds and coughs where he cant breathe. im so worried about him amd what his future is going to be like and with 2 other children i have my hands full. xx

  2. My son had the repair of the laryngeal cleft type 1, and larynogomalaca at 5 months old. It saved him. They also found because of the cleft he had puss in his lungs. They sucked that out. I am so thankful for modern medicine. My son is going great. You would never know he had these problems as a baby. Don't worry about your sons future-just focus on now. I don't know anything about the subglottic stenosis-but as far as the laryngeal cleft goes, the surgery can fix it. I recomend the surgery. It works like a miracle!! Hang in there. You can get through this. I know how you feel about your hands full. My little guy is baby #4. I am glad I was a more experienced mom when he came around with his health issues. I might have been afraid to have more kids. Just remember special babies are born to special mommies. Be strong, take one day at a time, trust your gut, get 2nd opinions if you feel you need to, be your childs advocate. Best wishes, Liz