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Pediatric Otolaryngology

(397) Predictors of Success in Endoscopic Cleft Repair in Pediatric Patients

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
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    Presenting Author(s)

  • Niketna Vivek, BA

    Medical Student (M2)
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    • Co-Author(s)

  • Niketna Vivek, BA

    Medical Student (M2)
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

  • OZ

    Oliver Zhao, BS

    Medical Student
    Vanderbilt University Medical Center
    Olathe, Kansas, United States

  • Anvith P. Reddy, MS

    MD/PhD Student
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

  • PK

    Peter Karempelis, MD

    Vanderbilt University Medical Center, TN, USA

  • HC

    Heidi Chen, PhD

    Research Associate Professor
    Vanderbilt University Medical Center
    Brentwood, Tennessee, United States

    • Senior Author(s)

  • Lyndy Jane Wilcox, MD

    Assistant Professor
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

Disclosure(s):
Niketna Vivek, BA: No relevant relationships to disclose.
Oliver Zhao, BS: No relevant relationships to disclose.
Anvith P. Reddy, MS: No relevant relationships to disclose.
Heidi Chen, PhD: No relevant relationships to disclose.
Lyndy Jane Wilcox, MD: No relevant relationships to disclose.


Introduction: This study evaluates predictors of success for endoscopic repair of a type 1 laryngeal cleft (LC1) or deep interarytenoid notch (DIN) in pediatric patients.

Methods: A retrospective chart review of children ages 0-18 years who underwent endoscopic repair of a LC1 or DIN was performed at a single quaternary care pediatric hospital September 2018 through June 2022. Demographics, birth history, surgical information, feeding history, and swallow function were collected. Videofluoroscopic swallowing study (VFSS) results were examined before and after the procedure. Success in cleft repair was defined as subjective patient-reported symptom improvement or improvement on VFSS recommended feeding status after intervention. McNemar or McNemar-Bowker tests were used to assess the symptom improvement pre to post operation. Group comparison for patient reported improvement was assessed using Pearson Chi-square test.

Results: A total of 31 patients were included in the study. Patients had a median age of 13 months at diagnosis and 3.4 years at time of surgical repair. Of those with aspiration on the VFSS, 58% had resolution postop (p=0.023). The severity of dysphagia decreased (p=0.046) with no patients having severe dysphagia after repair. There was a 50% reduction in the number of patients able to tolerate thin liquids after repair. The only patient factor showing a significant correlation with lack of improvement after surgery was the presence of pregnancy complications (x²=4.2, P = 0.041). Preterm birth, history of a NICU stay, prior airway and feeding interventions, and the presence of a syndrome were not significantly correlated with outcomes.

Conclusions: Operative intervention in patients undergoing endoscopic repair showed a statistically significant reduction in aspiration events and severity of dysphagia. History of pregnancy complications was associated with worse outcomes. Small sample sizes may limit the ability to identify other significant risk factors, which often coexist with pregnancy complications.