Berzofsky Craig E, Lando Tali, Ettema Sandra, Nelson Jennifer, Woodson Gayle
1 ENT Faculty Practice, LLP/New York Medical College, Arsdley, New York, USA.
2 Southern Illinois University, Springfield, Iliinois, USA.
Ann Otol Rhinol Laryngol. 2018 Apr;127(4):217-222. doi: 10.1177/0003489417752187. Epub 2018 Jan 17.
Type 1 laryngeal cleft (T1LC) is a congenital deficiency in the posterior glottis, resulting in a communication between the hypopharynx and glottis. No consensus treatment paradigm exists for timing and criteria for patient selection for surgical repair. Our goal is to assess whether patient characteristics can help predict improvement after surgery.
After Institutional Review Board exemption, a retrospective chart review was performed for patients undergoing surgery to diagnose a T1LC. Charts were examined for age, presenting symptoms, comorbidities, pre/postoperative videoflouroscopic swallow study reports, and outcomes.
Ninety-seven patients with clinical suspicion for T1LC underwent direct laryngoscopy and bronchoscopy, and 63 (64%) were diagnosed with a T1LC. Twenty-two patients (63%) undergoing surgery achieved clinical or radiographic improvement. There was no difference in average age, aspiration, or penetration between clinical improvement and no improvement groups. Of 13 patients with comorbidities that increase their risk of aspiration, 12 were significantly improved. There were 5 complications, which were managed conservatively.
Our experience supports the repair of T1LC repair at time of diagnostic laryngoscopy if satisfactory improvement is not noted with conservative treatment. This should be performed without segregation for age, comorbidities, or degree of dysphagia. Our technique is performed with minimal complications and achieves satisfactory results.
1型喉裂（T1LC）是声门后部的先天性缺陷，导致下咽与声门之间相通。对于手术修复的时机和患者选择标准，目前尚无共识性的治疗模式。我们的目标是评估患者特征是否有助于预测手术后的改善情况。
在获得机构审查委员会豁免后，对接受手术诊断T1LC的患者进行了回顾性病历审查。检查病历以了解年龄、出现的症状、合并症、术前/术后视频荧光吞咽研究报告及结果。
97例临床怀疑T1LC的患者接受了直接喉镜检查和支气管镜检查，其中63例（64%）被诊断为T1LC。22例接受手术的患者（63%）实现了临床或影像学改善。临床改善组与未改善组在平均年龄、误吸或渗透方面无差异。在13例存在增加误吸风险合并症的患者中，12例有显著改善。有5例并发症，均采取保守治疗。
我们的经验支持，如果保守治疗未取得满意改善，则在诊断性喉镜检查时进行T1LC修复。应不分年龄、合并症或吞咽困难程度进行修复。我们的技术并发症最少，效果满意。
