Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta-analysis

Abstract

Objective: Endoscopic surgical management or injection laryngoplasty of type 1 laryngeal clefts in pediatric patients is used in those who do not respond to conservative treatment. This study compares conservative treatment, endoscopic surgical repair, and injection laryngoplasty for the management of type 1 laryngeal clefts.

Data sources: PubMed, Web of Science, and Embase.

Review methods: This systematic review included studies of patients with type 1 laryngeal clefts who were managed with conservative treatment, injection laryngoplasty, or endoscopic repair, and all studies reported postintervention outcomes. Two independent investigators assessed study eligibility, rated the quality, and extracted data for analysis. A random effects model was used for meta-analysis of pooled data.

Results: Of the 1209 studies identified, 27 met inclusion criteria. There were 543 patients with type 1 laryngeal clefts represented in the studies, with outcomes reported for 537. Conservative therapy had a 52% (95% CI, 37%-66%; I² = 63%) success rate at improving symptoms, while endoscopic repair had a significantly higher percentage resolution of symptoms (70%; 95% CI, 59%-79%; I² = 62%, P < .001) as compared with conservative treatment (51%; 95% CI, 36%-65%; I² = 62%) or injection laryngoplasty (36%; 95% CI, 20%-57%; I² = 70%). The quality scores of the studies ranged from 7 to 12 out of 16.

Conclusion: Our systematic review demonstrated significant improvement and resolution of symptoms for patients with type 1 laryngeal clefts treated with endoscopic repair as compared with other modalities. More prospective and controlled studies comparing treatment strategies with validated instruments to measure outcomes are necessary to determine their efficacy in the management of type 1 laryngeal clefts.

Keywords: endoscopic; injection laryngoplasty; laryngeal cleft; meta-analysis; systematic review.