ABOUT THE CONDITION
What is a laryngeal cleft?
When a baby is formed, the foodpipe and the windpipe are formed together. They separate in the womb. The windpipe forms at the front and the foodpipe at the back. The voice box sits above the windpipe. Sometimes, a gap, known as a cleft, remains at the back of the voice box. This gap can be anything from a small dent in the voice box to a large hole into the windpipe.
What symptoms will my child have?
When we swallow, the voice box protects the windpipe and lungs from food and liquid going the wrong way. If your child has a cleft, food and drink may end up in the lungs. This is called aspiration and may cause chest infections.
Figure 1. Position of the throat, voicebox, windpipe and lungs
If your child has trouble swallowing, they will need to be examined by a swallowing and speech therapist. The swallowing problem could be caused by the gap, or by something else.
ABOUT THE OPERATION
How is the cleft treated?
If your child has a small gap, this can be treated by injecting a gel into the gap, to bulk it up. This is called a laryngeal cleft injection or an inter-arytenoid injection for augmentation of laryngeal cleft.
This closes the gap between the voice box and windpipe. The injection is given through your child’s mouth using a wide tube. Your child will be asleep during the operation.
Figure 2(a) injection of the gel (b) picture of the voicebox before injection (c) picture of the voicebox after injection.
How long does the effect last?
The effect of the gel used usually lasts between 12 to 18 months.
Does it always work?
The aim of the operation is to stop liquids from ending up in your child’s lungs when they swallow. Most children who have the operation will benefit from it:
- 1 in 3 children improve a lot
- 1 in 3 children improve a little
- 1 in 3 children do not see any changes
Your child may need more than 1 injection as it wears out with time.
Why might my child’s swallowing not improve?
The injection helps your child’s swallowing by closing the gap between their voice box and windpipe. Your child may also find the actions of swallowing difficult. The injection may not help in this case. A swallowing and speech therapist can help your child with this.
Are there alternatives to the injection?
Instead of the injection, the gap can be closed by stitching the tissue together at the back of the voice box. This can be done through the mouth and throat, or through an opening in your child’s neck.
This is more complex and may require a 1 to 2-night stay in hospital. Your child might need a feeding tube whilst the area heals.
Are there any complications to this operation?
All surgery involves some risks. Complications fall into the following groups.
Sore throat
Your child may have a sore throat after the procedure. This is common. Painkillers can be given.
If the sore throat does not go away or your child develops a high temperature (38oC or above) after leaving the hospital, please call the hospital department or your GP. This is uncommon.
Damage to teeth, lips and gums.
Your child’s doctor uses a metal tube to look at your child’s voicebox. This sits on the teeth. There is a small risk of minor injury or bruising to your child’s tongue, gums, lips or teeth.
It is uncommon to damage, chip or dislodge a tooth. If your child has any loose teeth, please let the surgeon and anaesthetist know before the operation.
Swelling of the airway
The endoscope could damage your child’s airway, cause swelling which can affect their breathing. This is uncommon. Steroids may be used to bring down the swelling.
Your child may need to remain intubated for a short period of time after the surgery. This means they will be kept asleep with a tube to help them breathe until the swelling settles down. This is rare.
If your child has trouble breathing when they leave hospital, take them to the nearest Emergency Department straight away.
Injection material tissue reaction
The voice box tissue may react to the injection. This forms a swelling called granulation tissue around the injection site. This is rare. Most of the time this will settle down on it is own. The swollen tissue and the injection material may need to be removed with another operation. This is very rare.
General anaesthetic
The operation takes place under general anaesthetic. This is very safe in children. Your child’s pre-assessment team will inform you about the risks of a general anaesthetic. For more information, click here.
AFTER THE OPERATION
What happens after my child’s operation?
After the operation, your child will go to the recovery area. They will go back to the day surgery unit if the surgery was performed as a day case. If they are staying overnight, they will be taken to the ward.
How long will my child be in hospital?
Your doctor will tell you if your child can go home on the same day or if they should stay overnight.
When can my child eat?
Your child can usually be fed later the same day, when they are fully awake. Feeding your child will be the same as before the procedure. Inform your child’s doctor if you have noticed your child coughing after eating.
Your child will have a new swallow assessment 4 to 6 weeks after the operation.
Follow up
Your child’s doctor will tell you when they will be reviewed in clinic.
Disclaimer: This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information contained may not be comprehensive and patients should not act upon it without seeking professional advice.