Weissbrod Philip A, Inglis Andrew, Merati Albert L
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego Health System, San Diego, California, USA.
Ann Otol Rhinol Laryngol. 2012 Aug;121(8):533-8. doi: 10.1177/000348941212100807.
We present the clinical characteristics of a case series of adult patients with type III laryngeal clefts according to the classification of Benjamin and Inglis, in an attempt to make practitioners aware of the "ram sign," a clinical finding associated with laryngeal clefts in adults. Laryngeal clefts are uncommon defects that are nearly universally identified during infancy as a result of persistent aspiration and pneumonia. Undiagnosed laryngeal clefts in adults are extremely rare.
Three type III laryngeal clefts were identified in adults (29, 48, and 60 years of age) from one clinic over an 18-month period. The existing literature features only one type III cleft, to our knowledge. The 60-year-old patient represents the oldest person in the English-language literature to have a newly diagnosed laryngeal cleft. All three cases presented with various degrees of aspiration over an extended period.
The computed tomographic imaging and endoscopic findings from these three patients were reviewed. The videolaryngoscopic images demonstrated that the "ram sign"--an endoscopic finding associated with redundant soft tissue overlying the arytenoid cartilages that prolapses into the cleft, creating the appearance of ram's horns--was a consistent and striking feature in all three patients.
Although rare, laryngeal clefts may represent an underdiagnosed entity in the adult population. With increased awareness, they may be identified more frequently as a treatable cause of aspiration and recurrent pneumonia.
我们根据本杰明和英格利斯的分类法，展示一系列成年III型喉裂患者的临床特征，旨在让从业者了解“公羊征”，这是一种与成年喉裂相关的临床发现。喉裂是罕见的缺陷，几乎在婴儿期就因持续呛咳和肺炎而被普遍发现。成人未诊断出的喉裂极为罕见。
在18个月期间，从一家诊所的成年患者（年龄分别为29岁、48岁和60岁）中识别出3例III型喉裂。据我们所知，现有文献仅报道过1例III型喉裂。这位60岁的患者是英文文献中被新诊断出喉裂的年龄最大的人。所有3例患者长期以来均有不同程度的呛咳表现。
回顾了这3例患者的计算机断层扫描成像和内镜检查结果。电子喉镜图像显示，“公羊征”——一种内镜下表现，即杓状软骨上方多余的软组织脱垂至裂隙中，形成公羊角的外观——在所有3例患者中均为一致且显著的特征。
尽管罕见，但喉裂在成年人群中可能是一种未被充分诊断的疾病。随着认识的提高，它们可能会作为可治疗的呛咳和复发性肺炎病因被更频繁地识别出来。
