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Endoscopic Repair of Type 1 Posterior Laryngeal Cleft

1. Purpose of the Procedure: To repair a type 1 posterior laryngeal cleft that is resulting in feeding difficulty and aspiration which fails medical management.

2. Instruments: Parsons Laryngoscope, Lindholm vocal fold spreader (Karl Storz 8654B), Double armed 5.0 Vicryl 45 cm dyed suture on a tapered needle, Omniguide carbon dioxide laser (5 watts, pulsed mode), Microlaryngoscopy right sided curved alligator, Knot pusher

3. Landmarks: The false vocal folds should be separated with a Lindholm vocal fold spreader allowing for good visualization of the interarytenoid region.

4. Procedure:
a. Parson’s laryngoscope placed in the vallecula and in suspension with spontaneous ventilation
b. Lindholm vocal fold spreader inserted exposing the interarytenoid region.
c. Interarytenoid region is demucosalized in a diamond shape with a carbon dioxide laser (5 watts, pulsed mode). The char is wiped clean with a pledglet.
d. A double armed needle with a dyed 5.0 tapered Vicryl suture should be loaded on to a right sided microlaryngoscopic curved alligator in “fishhook” fashion. One arm is pushed through the right side and one arm is pushed through the left side of the corners of the demucosalized region. This will ensure that the knot sits posteriorly. (A dyed suture will also allow for easy visualization of the suture postoperatively in the office)
e. Clinical swallow evaluation on postoperative day #1. Postoperative follow up and swallow study on Day #7. Additional follow up on postoperative day #30

5. Conflict of Interest: none

6. No references

DOI: http://dx.doi.org/10.17797/f0jsgqdoup

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