Long-Term Follow-Up of Dysphagia After Type I Laryngeal Cleft Repair.

Objective

To evaluate the long-term course of dysphagia after surgical treatment of Type I laryngeal cleft (LC-1).

Methods

A retrospective review was conducted on consecutive children with persistent swallowing dysfunction after surgical treatment of LC-1. Swallowing function was assessed using a video fluoroscopic swallow study (VFSS) at follow-up. VFSS findings were assessed using the penetration aspiration scale (PAS) and functional oral intake scale (FOIS) scores. PAS and FOIS scores were compared within the follow-up period. p < 0.05 was considered significant.

Results

Twenty-one patients with persistent dysphagia (13 male, 8 female, age range: 5 months to 16 years) after endoscopic repair (n = 16) or injection laryngoplasty (n = 5) for LC-1 (n = 5) were followed for 1-6.2 years. Most patients were White (71%) and non-Hispanic (67%); 90% had comorbid conditions. Swallowing abnormalities were observed in the oral phase in 10 patients, swallow triggering in 8, pharyngeal phase in 19, and esophageal phase in 5. In five children (24%), impairments in all phases of swallowing were resolved. Impairment of the oral phase resolved in seven patients (70%), pharyngeal phase in seven (38%), esophageal phase in five (100%), and swallow triggering in six (75%). PAS scores continued to improve, with median scores decreasing from 5 postoperatively to 3 at the last follow-up (p = 0.03). FOIS scores continued to improve, with median scores increasing from 4 postoperatively to 5 at the last follow-up (p < 0.001).

Conclusion

The impairment in multiple phases of swallowing continued to improve after surgical treatment of LC-1. Further research is necessary to determine the factors that predict improvement in long-term swallowing function in larger groups of children with LC-1. LEVEL OF EVIDENCE: 4