Laryngeal Cleft

There are two tubes or passageways inside your neck or throat: 

  • The esophagus, which helps food and liquid pass from mouth to stomach
  • The trachea (windpipe), which takes oxygen to our lungs as we breathe in   

The larynx (our voice box) sits at the top of the trachea, right next to the esophagus and helps keep any food or liquid from getting into the tube leading to our lungs.

What is a Laryngeal Cleft (or Laryngotracheoesophageal Cleft)?

The larynx and the esophagus should not have any type of space or gap between them.  When a gap exists, it is known as a laryngeal cleft.  With a cleft, food or liquids can go into the airway tube when the child swallows. This causes a number of eating and breathing problems.

A child with a laryngeal cleft can have a wide range of signs and symptoms including:

  • Coughing
  • Choking with feedings
  • Shortness of breath
  • Poor weight gain
  • Hoarseness
  • Short pauses when breathing (apnea)
  • Noisy breathing (stridor)
  • Frequent lower respiratory infections (pneumonia)
  • Food and / or liquid going into the lungs (aspiration)
  • Gastric esophageal reflux

Children are born with a laryngeal cleft. This means it is present at birth (congenital).  We do not know what causes a laryngeal cleft to occur, but it happens during the early months of pregnancy.

A laryngeal cleft is diagnosed with a microlaryngoscopy and bronchoscopy.  Sometimes the child may need other X-rays or tests to evaluate for aspiration (food / liquid going into the lungs) or other abnormalities. 

The cleft can vary from mild to severe; depending on how big the gap is between the esophagus and the airway.

  • A type I laryngeal cleft is a gap that is located above the vocal cords. This is the mildest form.
  • A type II laryngeal cleft extends below the vocal cords into the lower cartilage of the voice box. 
  • A type III laryngeal cleft extends beyond the voice box and into the trachea (windpipe).
  • A type IV laryngeal cleft extends even further down into the windpipe, and may go all the way to the bottom of the trachea. This is the most severe form.

We take a holistic approach to assessing and diagnosing our patients. We assess all aspects of a child and individualize a treatment plan that encompasses all levels of care. Doctors in multiple disciplines work together to determine the best course of action for your child. Your child’s needs are discussed with you and your family, leading to an integrated, customized treatment plan.

Some children, who have few symptoms and minor clefts, do not need surgery.  Instead they are checked often for any changes in their symptoms.   

If a child continues with aspiration or breathing concerns, the doctor will discuss what care options or surgeries are best for the child. 

Surgery for this condition is called a laryngeal cleft repair. It is required for patients with types II, III or IV. The repair most often involves making an incision in the neck, opening up the larynx, and closing the laryngeal cleft with sutures.

If your child has difficulty breathing, call 911.

Call your child’s doctor if your child struggles to swallow his / her food, coughs or chokes often when eating or is not gaining weight.

If you have any questions, contact the Division of Pediatric Otolaryngology / Head and Neck Surgery at Cincinnati Children’s, 513-636-4355, ent@cchmc.org.


Last Updated 03/2015