Introduction
Laryngeal cleft (LC), a fissure defect between laryngotrachea and upper
esophagus, is a rare congenital anomaly occurring in less than 0.1% of
the general population.1-3 LC is important to be early
recognized to prevent unnecessary diagnostic work-up, medication and
associated morbidities. The main presenting symptoms of stridor, chronic
cough and recurrent aspiration are non-specific. Direct visual
confirming its presence and identifying type are clinically challenging.
Rigid endoscopy (RE) is capably separating and inspecting
inter-arytenoids and hypopharyngeal region, therefore, being recommended
as confirmatory diagnosis of LC.3-7 However, due to
the need for general anesthesia, lack of RE expertise in many centers,
the application of RE can be challenging in common practices for
diagnosing LC.
Flexible endoscopy (FE) allows direct inspection of the dynamic
structures of pharyngolaryngeal space (PLS) and aeroesophageal tracts
(AET), therefore is the preferred first-line visual
examination.8,9 However, defects in the posterior
larynx may not be readily noticeable due to the inherent collapse
hypopharynx, which usually displays a normal appearance. Even with
apparent symptoms and a high index of suspicion, LC could still be
overlooked by experienced operator using traditional FE
technique.3,10,11 Trachsel’s group published a report
of FE assisted with using continuous positive airway pressure via an
endoscopy face mask for the diagnosis of LC.12 We here
like to share our experiences by applying a more simple technique of
positive airway pressure (PPV) to evaluate LC.
“Pharyngeal oxygen with optional nose-closure and abdomen-compression
(PhO2-NC-AC)” is a novel technique of noninvasive
ventilation (NIV).13-15 Clinically, it is a safe and
convenient method of producing PPV without using any ventilation or
airway devices of Ambu-bag, face mask, nasal prong, laryngeal mask
airway, endotracheal tube or ventilator. FE with this NIV (FE-NIV) can
ensure adequate oxygenation during many interventional procedures of AET
in pediatrics, even in severe asphyxiated status.16-18In this NIV, maneuvers of prolonged nose-closure, 1 to 5 second, can
create sustained pharyngeal inflation (SPI) with enough, dynamic and
controllable PPV to expand the PLS and allows precise FE
assessment.19 Over the last two decades, we have
routinely using this FE-NIV and SPI (FE-NIV-SPI) technique and have
successfully detected many LC lesions at their first FE inspection of
larynx.
We like to share our experiences using this novel FE-NIV-SPI technique
alone to screen for LC lesions and report characteristics of our
patients.