Short-term swallowing outcomes following type 1 laryngeal cleft injection

Introduction: Interarytenoid injection augmentation at the time of initial diagnostic endoscopy for aspiration and dysphagia may result in near-immediate improvement in swallowing function, potentially obviating the need for future formal endoscopic repair of type 1 laryngeal cleft. Interarytenoid injection augmentation may also address physiologic aspiration. Early treatment of type 1 laryngeal cleft may allow for expedited liberalization of feedings. The objective of this study was to evaluate the effect of interarytenoid injection augmentation (HA) for type 1 laryngeal clefts (LC-1) on short-term swallowing function assessed by videofluoroscopic swallowing study (VFSS). Methods: This was a retrospective cohort study of patients age 24 months with dysphagia on preoperative VFSS who underwent IIA with calcium hydroxyapatite for LC-1 during direct laryngoscopy and bronchoscopy from June to October 2017 at a tertiary care academic subspecialty hospital. Exclusion criteria included prior endoscopic or open LC repair (n = 1), gastrostomy tube dependence (n = 1), additional procedures at the time of IIA (supraglottoplasty, frenulectomy, n = 1). Children without postoperative VFSS within 30 days of injection were excluded (n = 2). Fifteen children met inclusion criteria for analysis. The primary endpoint was improvement in safely swallowed consistency as defined by recommendation to liberalize diet by at least a half-consistency (e.g. half-honey to nectar thick liquid). Secondary endpoints included clinical assessment of dysphagia and postoperative respiratory events. Results: Median [range] age at injection was 15.2 [7.7-24.3] months and 67% of patients were female (n = 10). The majority (13/15) of patients were full-term and 80% of patients (n = 12) had documented gastroesophageal reflux disease (GERD). Median time from injection to VFSS was 16 [9-29] days. Improvement in safely swallowed consistency was noted in 60% (n = 9) of patients. Aspiration completely resolved in two patients. Swallow function was unchanged in 40% of patients (n = 6); no patients experienced worsening dysphagia. No respiratory complications were documented during inpatient observation. Conclusion: HA is a safe procedure that may result in immediate improvement in dysphagia in select patients with LC-1. IIA does not address neurologic, developmental, or other anatomic etiologies of dysphagia. Additional studies are required to determine long-term efficacy of IIA on dysphagia and pulmonary complications, as well as the patient- and caregiver-related outcome measures.