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A laryngeal cleft is a connection between the back part of the airway and the esophagus. Less severe clefts involve just the larynx, more severe clefts extend into the trachea. The cleft makes it hard to protect the lungs from aspirating food, drink, saliva, and esophageal contents. While less severe clefts can commonly be repaired endoscopically, more severe clefts require more extensive surgery.
Open repair is typically used for severe clefts. An incision is made in the front of the neck and the strap muscles are identified and divided in the midline and retracted. The larynx and the trachea are then divided in the midline, using care to make sure not to injure the vocal cords. The cleft is visualized in its entirety. Mucosal flaps are elevated along the length of the cleft to separate the esophagus from the trachea and the larynx. The esophageal side is closed first starting from the bottom of the cleft with interrupted sutures. The knots are left in the esophageal lumen. An interstitial graft of periosteum from the sternum, clavicle or tibia is placed between the two layers. The tracheal mucosa is then closed with the knots in the airway lumen. The airway is then closed, beginning with the larynx to assure the vocal cords are approximated at the same level. The wound is then closed leaving a penrose drain on top of the strap muscles.
Credits: Media Lab at Cincinnati Children's @CincyKidsMedArt
Animation: Jeff Cimprich, Matt Nelson, and Cat Musgrove
Media Lab direction and additional content expertise: Ken Tegtmeyer, MD
Content Experts: Alessandro de Alarcon, MD, MPH and Andrew Redmann, MD
Voice Over: Alessandro de Alarcon, MD, MPH
