Does your baby often choke when he drinks or eats? Or does he make a strange noise when he breathes, or does he often have difficulty breathing? Sometimes, as a mother or father, it is very normal for you to feel very scared and worried when you see these things. Today we are going to talk about a congenital condition that can show similar symptoms, but is not very common among many people. This condition is called a laryngeal cleft . Although the name may sound a bit complicated, let's understand it simply.
What is a Laryngeal Cleft?
Simply put, a laryngeal cleft is a small gap or slit in the tissue that should be between our babies' throats, that is, the voice box (larynx) and the food pipe (esophagus). Think about it, our voice box is above the windpipe (trachea). The food pipe is behind this voice box. So, if there is an abnormal gap between these two, the things that the baby eats, that is, milk, water, and food can go through that gap into the windpipe instead of going into the stomach. That's when the problems start. This is a very rare congenital condition . This condition occurs in approximately one in 10,000 to 20,000 live births. It is slightly more common in boys.
It is important to identify and treat a baby with this condition as soon as possible, because if food or drink goes to the wrong place, it can cause a variety of problems. However, the severity of this laryngeal cleft depends on the size of the cleft and its location.
What are the main types of laryngeal clefts?
Doctors divide laryngeal clefts into four main types, depending on their severity. Let's take a look at what they are:
- Type I: This is the mildest type. The cleft is only in the baby's vocal cords. This type often does not cause major symptoms. Therefore, it may not be recognized immediately.
- Type II: Here the cleft extends below the baby's vocal cords.
- Type III: The cleft is slightly larger. It may extend beyond the baby's voice box (larynx) and into the windpipe (trachea).
- Type IV: This is the most severe type. Here, the cleft extends further down the baby's windpipe. Sometimes, the cleft can extend along the entire windpipe.
Now you understand how far the gap has affected this classification.
What are the symptoms of a laryngeal cleft?
When your baby has a laryngeal cleft, it can make it difficult for them to eat and breathe. Common symptoms include:
- Coughing and choking while breastfeeding or feeding: This is often the first symptom you see. It's like when a little baby is given some milk and starts to choke, gag, and sometimes the milk comes out of their nose.
- Trouble swallowing: The baby refuses to eat, or seems to have great difficulty swallowing.
- Blue skin (Cyanosis): This blue discoloration (cyanosis) is easily seen in the gums, lips, fingernails, and around the eyes, especially in babies with dark skin. This occurs when the body is not getting enough oxygen.
- A hoarse, wet, harsh sound when breathing: It can sound like mucus is stuck in the throat.
- Constant crying due to hunger, restlessness, and not sleeping well: A baby may feel hungry all the time because food is not going into the stomach properly.
- Failure to gain weight, delayed growth: If a baby is not gaining weight or growing at the same rate as other babies of the same age, no matter how much milk or food is given, this should be considered suspicious.
- Aspiration of food or drink into the windpipe: This can lead to frequent lung infections.
- Frequent occurrence of pneumonia: This happens due to the aspiration condition mentioned above.
If your baby has one or more of these symptoms, it is very important to seek medical advice immediately.
What causes a laryngeal cleft?
Researchers still don't know the exact cause of this condition. However, it is thought to be something that occurs during the first few months of a baby's development in the womb. It can occur on its own, or it can be associated with certain genetic syndromes. For example:
- Opitz-Frias Syndrome
- VACTERL Association
- Pallister-Hall Syndrome
- CHARGE Syndrome
More than half of babies with laryngeal clefts may also have other birth defects. Some of these include:
- Tracheobronchomalacia - weakening of the windpipe
- Cleft lip and/or palate
- Heart and blood vessel anomalies
- Pulmonary agenesis - failure of one lung to develop
- Esophageal atresia - incomplete formation of the esophagus
- Tracheoesophageal fistula - an abnormal connection between the windpipe and the esophagus
Because this laryngeal cleft can be seen with other conditions like this, doctors are paying attention to this as well.
How is a laryngeal cleft diagnosed?
The milder types of laryngeal clefts, types I and II, can sometimes go undiagnosed for years because the symptoms are not as severe. However, the symptoms of types III and IV are so severe that they are usually diagnosed within the first few days after birth.
If your baby has the symptoms mentioned above, an otolaryngologist (ENT specialist) will often recommend an endoscopic evaluation. In this, the main test to find out if there is a laryngeal cleft is a microlaryngoscopy and bronchoscopy . Don't worry, this is done after the baby is given anesthesia and is completely asleep. Then the specialist inserts a tube with a small camera into the baby's windpipe and carefully examines whether there is a cleft.
Additionally, your child may be referred to a Speech-Language Pathologist (SLP). This specialist will look at how the condition is affecting your child's ability to speak and swallow.
How is a laryngeal cleft treated?
Most often, a laryngeal cleft requires surgery . This is called a laryngeal cleft repair. Surgery is especially necessary for types II, III, and IV. However, some babies with a small type I cleft may close on their own as they grow older. Such babies may only need medication to prevent food and drink from coming back up into the throat (reflux) and some measures to prevent food from going into the windpipe (aspiration).
The timing and method of surgery vary depending on the type of laryngeal cleft. Surgeons use the following methods to repair the cleft:
- Minimally invasive injection placement: Here, the surgeon injects a temporary filler into the area where the scar is. This can help relieve symptoms (usually for about three months). This provides relief until the baby is ready for surgery. Sometimes, this alone may be enough.
- Minimally invasive endoscopic surgery: Here, the surgeon usually uses a laser to remove the abnormal tissue in the incision, then closes the incision with sutures.
- Open surgery: Here, the surgeon makes a small incision in the baby's neck and repairs the cleft. This method is usually used for babies with type IV laryngeal clefts.
The most important thing is that before your baby undergoes surgery, the medical team will give the baby anesthesia. So the baby will not feel any pain . Don't worry about it.
Are there any complications or side effects of laryngeal cleft treatment?
As with any surgery, laryngeal cleft surgery can carry some risks. Some of these include:
- Abnormal tightening of the baby's esophagus.
- The stitches break or open.
- Noisy breathing or laryngomalacia.
- Damage to the nerves connected to the baby's voice box (larynx).
- Swelling of the area between the lungs in the chest (Mediastinitis).
- Air accumulation under the skin after surgery (Surgical emphysema).
- Constriction of the windpipe when breathing (Tracheomalacia).
The likelihood of this complication occurring depends on many factors, including the type of surgery performed, the type of scar, and the baby's overall health. Your baby's doctor will discuss this with you in detail before the surgery.
How long will it take for my baby to recover after treatment for a laryngeal cleft?
After the surgery, your baby will need to stay in the hospital for at least a day or two. Since stitches are placed to close the incision, it may take several weeks or months for the baby to fully heal . It is very important to follow your doctor's instructions carefully during this time.
What is the outlook for this situation?
If diagnosed and treated early , the outlook for babies with laryngeal clefts is very good . According to a recent study, 9 out of 10 babies who have laryngeal cleft repair surgery see improvement in their symptoms within six weeks. However, much depends on how severe the cleft is. Babies with a type IV cleft are more likely to have more than one surgery and to stay in the hospital longer.
Your baby's doctor will talk to you about your baby's condition and future care.
Does a laryngeal cleft shorten life expectancy?
For most babies, having a laryngeal cleft does not affect their lifespan. However, some babies with a very severe type IV laryngeal cleft and other serious birth defects can be life-threatening. However, death from a laryngeal cleft – even in severe cases – is extremely rare .
If treated properly and medical advice is followed, a laryngeal cleft should not shorten a baby's life span or reduce their quality of life.
When should I see my baby's doctor?
After surgery, your baby's doctor will probably ask you to come in for follow-up appointments every six months, up to a year. The number of visits during that time will depend on your baby's progress.
During these tests, the doctor may do imaging tests and ask you about your baby's symptoms. Be prepared to speak up for your baby. Talk to the doctor about any changes you notice in your baby's symptoms and overall health.
What questions should I ask my baby's doctor?
Here are some important questions to ask your baby's doctor:
- Why do you recommend this treatment or surgery?
- What can I do to help my baby be more comfortable before and after surgery?
- What are the risks of my baby's surgery?
- How long will it take for my baby to recover?
- What can I expect about my baby's long-term health?
Ask questions like these and explain everything you have.
Finally, what to remember (Take-Home Message)
If your baby is born with a laryngeal cleft, you will need to see a variety of specialists. They will all work together to provide the best care for your baby. Remember, sometimes the cleft may heal on its own. In that case, just watching your baby closely may be enough. If the cleft is severe, your baby may need surgery. The important thing is to remember that there are treatments that can help. In the meantime, ask your baby's doctor about things you can do to help your baby cope with this diagnosis. You are not alone, and the medical team is always there to help you and your baby.
👩🏽⚕️ Additional questions (FAQs)
💬 Is Laryngeal Cleft a Cleft Lip Disease?
No! A cleft lip is visible from the outside, but this one is not. Our throat has a wall separating the food pipe (esophagus) and the air pipe (trachea). However, in this birth defect, that wall does not form properly, leaving a 'hole' or cleft between the food pipe and the air pipe.
💬 How do you recognize this problem when breastfeeding a baby?
When this hole is present, the milk that goes into the food pipe when the baby drinks goes straight through the gap into the lungs (aspiration). This causes the baby to cough violently when drinking, has difficulty breathing, turns blue in the face, and develops frequent lung infections (pneumonia).
💬 How do you feed and drink a baby if there is a hole like this?
This must be closed with surgery. If the tear is very small, some control can be achieved by giving liquid food (milk) thickened with a little (thickeners). However, if the tear is large, a tube (G-tube) may have to be inserted directly into the stomach (stomach) until surgery can be performed.
` Laryngeal cleft, cleft palate, baby food choking, breathing difficulties, birth defects, runny nose, child health
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