September 2019 HSC Section 1 Congenital and Pediatric Problems

J.C. Yeung et al. / International Journal of Pediatric Otorhinolaryngology 101 (2017) 51 e 56

Fig. 1. Diagnostic Work-up of patients with suspected type I laryngeal cleft.

groove is made when the cleft approaches but does not reach the level of the true vocal folds. Several members (3/20, 15%) micro- scopically measure the interarytenoid height above the cricoid cartilage, and de fi ne a deep interarytenoid groove when this height is less than ~3 mm, but remains above the level of the true vocal folds [6,7] . Currently, evidence to functionally distinguish a deep interar- ytenoid groove from a true type I LTEC is lacking. Nevertheless, 95% (19/20) of members manage patients with a deep interarytenoid groove in a fashion that is similar to those with a type I LTEC. Because of these controversies and dif fi culties in the diagnosis of type I LTEC and/or deep interarytenoid groove, it is essential that the surgical intervention should not be solely based on the pres- ence of type I LTEC, but rather the functional issues caused by the cleft itself, namely respiratory issues, persistence of feeding dif fi - culty despite maximal medical management and feeding therapy.

6.3. Section 1.2: direct laryngoscopy and bronchoscopy

Using the clinical information provided by the above in- vestigations, the diagnostic bene fi t of an evaluation of the airway under general anesthesia is considered. The de fi nitive diagnosis of LTEC is made via direct laryngoscopy and bronchoscopy. One topic of debate, which was not accounted for in any of the previous LTEC classi fi cation systems, is the clinical signi fi cance of anatomic versus functional issues related to LTECs. Additionally, in a percentage of patients (reported < 25% by this panel), direct laryngoscopy under anesthesia does not clearly differentiate a normal larynx from a type I LTEC. These patients may be deemed to have a ‘ deep interarytenoid groove ’ . The de fi nition of a deep interarytenoid groove was also debated amongst members. The majority of members (85%, 17/20) rely solely on visual inspection of the interarytenoid area. The diagnosis of deep interarytenoid

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