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Laryngeal cleft, laryngotracheoesophageal cleft (LTEC), and laryngotracheal cleft (LTC) make up a spectrum of conditions that describe what happens when the airway doesn’t separate from the swallowing pathway as it normally should during development. Usually, there is a separation between the voice box and windpipe (larynx and trachea) and the esophagus, but with these conditions, there is an open connection between the two. This gap allows food, liquid, and saliva to pass through the larynx into the lungs. This can cause swallowing issues and aspiration (when food or liquid passes into the lungs), recurrent lung inflammation, and coughing and choking with feedings.
The vast majority of babies diagnosed with a laryngeal cleft are born with this condition. Occasionally, it can be caused by an airway surgery.
At Lucile Packard Children’s Hospital Stanford’s Aerodigestive and Airway Reconstruction Center, we have expertise in repairing all kinds of clefts, from mild to severe. We work closely with the cardiac surgery team and have extensive experience in open and endoscopic airway reconstruction.
Our approach is to consider both nonsurgical and surgical options after discussing a child’s options with our otolaryngology (airway surgery), pulmonary (lung), gastrointestinal (GI), nutritional, and speech-language pathology specialists. We work very closely with parents (and the patient, if old enough) to establish goals for the child, and we take pride in shared decision-making.
Patients with complex voice and swallowing disorders are also seen in our Pediatric Voice and Swallowing Clinic or in our Aerodigestive and Airway Reconstruction Program. These multidisciplinary clinics cater to the needs of children with complex breathing and swallowing concerns, and our team takes into account both the child’s immediate needs and future needs, such as his or her voice.
After minor repairs, children usually do very well and can eat and breathe well. We reevaluate the child’s swallowing about six weeks after surgery.
After more complex repairs, children go to one of our intensive care units (ICUs), where they are cared for by a team trained to manage patients after this surgery for a few days to a few weeks, depending on the kind of repair. After a child has recovered from surgery, the Aerodigestive and Airway Reconstruction Center physicians and therapists evaluate and optimize breathing, speaking, and swallowing.
The team then follows patients over time, including telehealth visits, to make sure these functions continue to do well and to make sure that patients reach their fullest potential.
Our patients may be seen at other programs at Packard Children’s, including the Pediatric Voice and Swallowing Clinic, Pulmonology, Pediatric Heart Surgery, and Gastroenterology, Hepatology and Nutrition.
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