• Nathan S Alexander, Judy Z Liu, Bharat Bhushan, Lauren D Holinger, and James W Schroeder.
• Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Greenville Health System, Greenville, South Carolina, USA.
• Otolaryngol Head Neck Surg. 2015 Jan 1; 152 (1): 153-8.

ObjectivesTo report the perioperative management and surgical outcomes in a large series of pediatric patients with endoscopically repaired type 1 posterior laryngeal cleft (PLC).Study DesignCase series with chart review.SettingUrban, tertiary care, free-standing pediatric hospital.Subjects And MethodsPatients who underwent endoscopic carbon dioxide laser-assisted repair of type 1 posterior laryngeal clefts between January 2006 and December 2012. Medical records were reviewed.ResultsFifty-four patients (34 male) underwent repair of type 1 PLC. Median age was 25.5 months (range, 2-120 months). Indications for repair included aspiration (n = 39; 72%), chronic bronchitis (n = 13; 24%), and stridor with feeds (n = 2; 4%). No children remained intubated postoperatively. Thirty-three patients (61%) stayed in overnight observation ("Obs PLC") and 21 patients (39%) stayed in the pediatric intensive care unit ("PICU PLC") postoperatively. Between Obs PLC and PICU PLC groups, there was no significant difference in age (mean 22 vs 30 months, respectively; P = .28). Comorbidities were similar between the groups. Symptoms improved in 41 of the 54 patients (76%). No postoperative complications were noted. Two patients required revision PLC repair. The cost of admitting a patient to a lower acuity location was estimated to be 60% less per day than cost of a PICU admission.ConclusionsThe endoscopic surgical repair of a type 1 PLC is successful and has a low morbidity and complication rate. Patients may be safely managed in an observation unit and without postoperative intubation. This approach achieved a marked cost reduction in postoperative care.© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

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