CPAP to diagnose laryngeal clefts by flexible endoscopy in infants

Abstract

Background: Laryngeal clefts (LC) are uncommon but important causes of stridor in infants. Direct laryngoscopy is the recommended method for the detection of LC because LC may be missed by flexible endoscopy. As laryngomalacia by far outnumbers any other cause of stridor in this age group flexible bronchoscopy is usually the preferred method for the evaluation of significant infantile stridor. The aim is to illustrate how the application of CPAP assists the detection of LC during flexible endoscopy.

Method: Continuous positive airway pressure (CPAP) is applied via endoscopy mask during flexible endoscopy, titrated to open the upper esophageal sphincter, and to spread the inter-arytenoid folds.

Results: The application of CPAP of 10-15 cmH₂ O resulted in visual unmasking of otherwise obscured LC in four young children assessed for congenital stridor.

Conclusion: CPAP helps visualize LC by flexible endoscopy obviating transition to direct laryngoscopy and manual exploration.

Keywords: CPAP; bronchoscopy; continuous positive airway pressure; endoscopy; laryngeal cleft; laryngotracheosesophageal cleft.