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Outcomes and predictors of surgical management in type 1 laryngeal cleft swallowing dysfunction
Author(s) -
Thottam Prasad John,
Georg Matthew,
Chi David,
Mehta Deepak K.
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26069
Subject(s) - swallowing , medicine , surgery , odds ratio , logistic regression , anesthesia , retrospective cohort study
Objectives/Hypothesis To examine the effect of and predict the success of type 1 laryngeal cleft (LC‐1) augmentation through swallowing evaluations. Study Design Retrospective chart analysis. Methods Sixty‐eight patients with LC‐1s underwent interarytenoid injection laryngoplasty (IL) and were examined. The median age at IL was 9 months. Swallowing evaluations were performed pre‐ and postoperatively using fiberoptic endoscopic examination of swallowing or modified barium swallow. The presence of aspiration or penetrations at various consistencies was recorded. McNemar's tests were used to detect changes in swallowing pre‐ and postoperatively. Logistic regression was used to assess factors affecting the odds of postoperative success. Results Preoperatively, 89.7% of patients demonstrated penetration or aspiration. Post‐IL, 69.1% were safe for thins, and 75% showed improvement in swallowing. Postoperatively, there was a significant reduction in patients experiencing problems with thin liquids ( P < 0.001) and in those with frank or silent aspiration ( P < 0.001). Patients with penetrations on thin liquids had higher likelihood of a successful IL (odds ratio [OR] = 3.68, P = 0.021). The probability of success with silent aspiration at any consistency was significantly decreased (OR = 0.26, P = 0.015). Fifteen patients underwent formal endoscopic surgical repair, and 90.0% were safe with thin consistencies postoperatively. Conclusion A large proportion of patients with LC‐1 and associated swallowing dysfunctions respond favorably to IL and formal repair. Children who demonstrated penetration with thin liquids had a higher rate of swallowing dysfunction resolution post‐IL; whereas patients demonstrating silent aspiration had poorer responses to IL. Level of Evidence 4. Laryngoscope , 126:2838–2843, 2016