Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Int J Pediatr Otorhinolaryngol. 2020 Nov;138:110370. doi: 10.1016/j.ijporl.2020.110370. Epub 2020 Sep 9.
To evaluate outcomes of injection laryngoplasty (IL) and endoscopic surgical repair for the treatment of type 1 laryngeal clefts (LC1) and to determine the most common presentations of LC1.
Primary studies were searched for in PubMed, Scopus, OVID, and Cochrane Library using search terms laryngeal cleft and laryngotracheoesophageal cleft for articles published from database inception through August 2019. The search identified all articles pertaining to the symptomatology and management of LC1. Meta-analysis was performed on presenting symptoms and improvement of clinical symptoms and swallow function.
Twenty-four studies, comprising 713 patients with a mean age of 33.7 months (range 0-168 months), were included. The most common presenting symptoms were aspiration (80%, CI [55%-96%]), dysphagia (61%, CI [47%-74%]), and choking (57%, CI [37%-76%]). Gastroesophageal reflux disease (GERD) was the most common comorbidity (68%, CI [51%-83%]) and premature birth comprised 27% [21%-32%] of the patients. Overall, 38% of patients received IL as a primary therapy. Prior to injection, 91% [87%-94%] of patients aspirated on swallow evaluations, and 62% [55%-68%] aspirated post-injection. At an average follow-up time of 6.8 months, 90% [70%-100%] of parents reported symptom improvement. An additional 54% of patients underwent endoscopic surgical repair as primary treatment. The rate of aspiration decreased from 73% [43%-94%] to 28% [13%-46%] after repair. At a mean follow-up of 14.2 months, 80% [67%-91%] reported symptom improvement.
A high level of clinical suspicion is necessary to detect LC1 since its most common presenting symptoms overlap with other diseases commonly found in this patient population. Both IL and formal surgical repair were effective in managing LC1.
评估喉成形术（IL）和内镜手术修复治疗 1 型喉裂（LC1）的效果，并确定 LC1 的最常见表现。
在 PubMed、Scopus、OVID 和 Cochrane Library 中使用“laryngeal cleft”和“laryngotracheoesophageal cleft”等检索词，对从数据库建立到 2019 年 8 月发表的文章进行初步检索。搜索范围涵盖了与 LC1 的症状和治疗相关的所有文章。对主要症状和临床症状及吞咽功能改善情况进行了荟萃分析。
纳入了 24 项研究，共 713 例患者，平均年龄 33.7 个月（0-168 个月）。最常见的主要症状为吸入（80%，置信区间 [55%-96%]）、吞咽困难（61%，置信区间 [47%-74%]）和窒息（57%，置信区间 [37%-76%]）。胃食管反流病（GERD）是最常见的合并症（68%，置信区间 [51%-83%]），早产儿占 27%[21%-32%]。总体而言，38%的患者接受 IL 作为一线治疗。在接受注射前，91%[87%-94%]的患者在吞咽评估时发生吸入，62%[55%-68%]的患者在注射后发生吸入。平均随访 6.8 个月后，90%[70%-100%]的家长报告症状改善。另有 54%的患者接受内镜手术修复作为一线治疗。修复后吸入率从 73%[43%-94%]降至 28%[13%-46%]。在平均 14.2 个月的随访中，80%[67%-91%]的患者报告症状改善。
由于其最常见的表现与该患者人群中常见的其他疾病重叠，因此需要高度怀疑才能发现 LC1。IL 和正式手术修复均可有效治疗 LC1。
