Health Library
Laryngeal Cleft

What Is a Laryngeal Cleft (or Laryngotracheoesophageal Cleft)?

There are two tubes in your neck or throat:

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

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

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.

Signs and Symptoms

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

  • 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

Causes of Laryngeal Cleft

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. It happens during the early months of pregnancy.

Diagnosing Laryngeal Cleft

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

Types of Laryngeal Cleft

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

  • A type I laryngeal cleft is a gap 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. It may go all the way to the bottom of the trachea. This is the most severe form.

Treatment of Laryngeal Cleft

We take a holistic approach to assessing and diagnosing our patients. We assess all aspects of a child and make a treatment plan to meet their unique needs and include all levels of care. Doctors in multiple disciplines work together to decide the best course of action for your child. Your child’s needs are discussed with you and your family. This leads to an integrated, treatment plan made to meet your child’s needs.

Some children, who have few symptoms and minor clefts, do not need surgery. These children 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 opening the larynx and closing the laryngeal cleft with sutures.

Call Your Child’s Doctor If:

  • Call 911 if your child has problems breathing.
  • Call your child’s doctor if your child struggles to swallow their food, coughs, or chokes often when eating or is not gaining weight.

Last Updated 10/2021

Reviewed By Sarah Vitolo, MSN, CNP

A Mother's Letter

Mom shares the lessons she learned from her daughter Emma, who was born with Down syndrome, tracheal rings and laryngeal cleft.