Diagnosis and management of type 1 laryngeal cleft: Systematic review

Abstract

Background: Laryngeal cleft (LC) poses a diagnostic challenge due to its rarity and non-specific clinical features. There is poor consensus regarding management as either conservative or surgical management may be appropriate for type 1 LC, given the spectrum of disease patients present with. The objective was to review the current literature and propose diagnostic and management pathways for type 1 LC. Methods: The study comprised a systematic review using data collected from PubMed, Medline and Cochrane library. A quality assessment of included studies was performed using a validated tool. A metaanalysis of proportions was performed for the outcome of each treatment modality using MedCalc software. Results: Of 674 potential studies, 19 were included. Complete resolution rates of conservative management, injection augmentation and endoscopic surgery were 52.3% (95% CI, 32.3-71.9%), 69.2% (95% CI, 59.1-78.1%) and 65.4% (95% CI, 49.1-80.1%) respectively. There are research survey, diagnostic and treatment algorithms, and radiological investigations presented in the literature to assist in constructing an updated management algorithm. Conclusions: We recommend that all patients receive initial 3-month trial of conservative therapy. Endoscopic surgery may be considered if conservative management fails or in the presence of other surgical indications. Injection augmentation may be performed prior to definitive surgical repair in selected patients who have comorbidities that increase aspiration risk to evaluate the potential effect of surgery.