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PubMed This is a summary of 50 peer-reviewed journal articles Updated
Otolaryngology · Laryngeal Cleft

Introduction to Laryngeal Clefts: A Guide for Parents

At a Glance

A laryngeal cleft is a treatable congenital gap between a child's airway and esophagus that can cause feeding and breathing issues. While it requires medical management to prevent lung damage, many mild cases are successfully treated without surgery using specialized feeding techniques.

Finding out your child has a rare condition can feel overwhelming, but a diagnosis is the first step toward getting them the right care. A laryngeal cleft (also known as a laryngotracheoesophageal cleft or LTEC) is a rare congenital anomaly where there is an opening between the larynx (the voice box/windpipe) and the esophagus (the tube that carries food to the stomach) [1][2].

Normally, these two tubes are completely separate. In a child with a laryngeal cleft, a gap exists in the wall between them, which can allow food or liquid to “leak” into the airway [3][4].

Stabilizing Realities for Parents

While the diagnosis is a shock, there are several key facts that can help ground you as you begin this journey:

01

Managing the Gap: Treatment Strategies for Laryngeal Cleft

Learn about laryngeal cleft treatment options for your child. Understand conservative management, feeding therapy, endoscopic surgery, and open repair methods.

02

Symptoms and Warning Signs of a Laryngeal Cleft

Learn to recognize laryngeal cleft symptoms in infants. Understand feeding issues, silent aspiration, recurrent pneumonia, and when to seek emergency care.

03

A Team Approach: Specialists and Related Conditions

Learn about the multidisciplinary care team for laryngeal clefts, including ENTs, SLPs, and GI doctors, plus associated conditions like VACTERL and EA/TEF.

Understanding the Cleft

Laryngeal clefts are categorized using the Benjamin-Inglis classification system (Types I through IV) based on how deep the gap extends into the airway [9][5]. You can find a detailed breakdown of these types and how doctors diagnose them in Classification and Diagnosis: Understanding the Gap.

Common Misunderstandings

  • “It’s just bad reflux”: While many children with a cleft also have gastroesophageal reflux (GERD), the cleft is a physical structural issue that reflux medications alone cannot fix [3].
  • “Surgery is the only option”: For many children with Type I clefts, conservative management—such as thickening liquids or using specialized feeding therapy—is the first and sometimes only treatment needed [5][10].
  • “It will heal on its own”: A laryngeal cleft is a physical gap that does not “grow shut” like a small cut. However, as a child grows, they may learn to compensate better, or the gap may become less symptomatic [11]. Importantly, even if outward symptoms seem to improve, unchecked silent aspiration can still cause permanent lung damage, making medical monitoring essential [12].

Why This Happened

A laryngeal cleft is a congenital condition, meaning it developed before your child was born [1]. It is extremely rare—though the exact incidence is hard to pin down because many mild cases go undiagnosed, it is estimated to occur in roughly 1 in 10,000 to 20,000 births [8][2]. It is not caused by anything you did or didn’t do during pregnancy. In some cases, it can occur alongside other conditions, such as esophageal atresia (where the esophagus doesn’t form correctly), so your doctors may perform additional screenings to ensure a complete picture of your child’s health [13][2].

For information on the recovery journey, see Life After Treatment: Recovery and The Road Ahead.

Common questions in this guide

What is a laryngeal cleft?
A laryngeal cleft is a rare congenital condition where there is an abnormal gap between the windpipe and the esophagus. This opening can allow food and liquid to leak into the airway, which leads to breathing and feeding difficulties.
Will a laryngeal cleft heal on its own?
No, a laryngeal cleft is a physical structural gap that does not grow shut on its own like a small cut. While a child might learn to compensate as they grow, medical monitoring is still essential to prevent silent aspiration and permanent lung damage.
Is surgery the only way to treat a laryngeal cleft?
Surgery is not always necessary. For many children with mild Type I clefts, conservative management like thickening liquids and working with a feeding therapist is the primary and highly effective treatment.
How do doctors categorize laryngeal clefts?
Doctors use the Benjamin-Inglis classification system to categorize clefts from Type I through IV. The specific type depends on how far down the gap extends into the child's airway.
Why did my child develop a laryngeal cleft?
A laryngeal cleft is a congenital condition, meaning it develops before birth. It is very rare, occurring in roughly 1 in 10,000 to 20,000 births, and is not caused by anything a parent did or did not do during pregnancy.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What type of laryngeal cleft does my child have according to the Benjamin-Inglis classification?
  2. 2.Does my child have any coexisting conditions, like neuromuscular issues or airway abnormalities, that might affect their recovery?
  3. 3.Is our immediate goal conservative management, such as thickening feeds, or are we discussing a surgical procedure?
  4. 4.How many laryngeal cleft repairs does this surgical team perform each year?
  5. 5.What specific symptoms (like coughing or wet breathing) should I monitor most closely at home?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (13)
  1. 1

    [Clinical diagnosis and treatments of type Ⅱ-Ⅳ congenital laryngotracheoesophageal cleft in 8 children].

    Zhao J, Wang GX, Wang H, et al.

    Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 2021; (56(9)):972-976 doi:10.3760/cma.j.cn115330-20201029-00839.

    PMID: 34666447
  2. 2

    [Pediatric laryngeal clefts: an experience in the diagnosis and management of 13 cases].

    Wu ZB, Li L, Pan HG, et al.

    Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 2017; (52(9)):681-685 doi:10.3760/cma.j.issn.1673-0860.2017.09.009.

    PMID: 28910893
  3. 3

    Type 3 Laryngeal Clefts Presenting with Upper Airway Obstruction without Aspiration.

    Weitzman RE, Shah HP, Modi VK, Maurrasse SE

    The Laryngoscope 2024; (134(2)):977-980 doi:10.1002/lary.30849.

    PMID: 37436152
  4. 4

    Presentation and management of type 1 laryngeal clefts: A systematic review and meta-analysis.

    Reddy P, Byun YJ, Downs J, et al.

    International journal of pediatric otorhinolaryngology 2020; (138()):110370 doi:10.1016/j.ijporl.2020.110370.

    PMID: 33152963
  5. 5

    Laryngeal cleft: A literature review.

    Martha VV, Vontela S, Calder AN, et al.

    American journal of otolaryngology 2021; (42(6)):103072 doi:10.1016/j.amjoto.2021.103072.

    PMID: 33957543
  6. 6

    Outcomes of surgical repair of Type III and IV laryngotracheoesophageal clefts with posterior cartilage grafting.

    Tan L, Li Q, Chen C

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2024; (281(9)):4881-4887 doi:10.1007/s00405-024-08701-1.

    PMID: 38761217
  7. 7

    [Evaluation and treatment of children's laryngeal clefts].

    Chen C, Tan LT, Xu ZM

    Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 2018; (53(1)):9-15 doi:10.3760/cma.j.issn.1673-0860.2018.01.003.

    PMID: 29365373
  8. 8

    Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit.

    Ishii A, Christophel E, Chollet M, Sandu K

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2024; (281(1)):283-294 doi:10.1007/s00405-023-08263-8.

    PMID: 37816841
  9. 9

    Current management of type III and IV laryngotracheoesophageal clefts: the case for a revised cleft classification.

    Jáuregui EJ, Propst EJ, Johnson K

    Current opinion in otolaryngology & head and neck surgery 2020; (28(6)):435-442 doi:10.1097/MOO.0000000000000669.

    PMID: 33109943
  10. 10

    Management of Symptomatic Grade I and II Laryngeal Cleft: Experience of a Tertiary Care Center and Review of Literature.

    Nayak A, Chappity P, Pradhan S, et al.

    Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2022; (74(Suppl 2)):2367-2371 doi:10.1007/s12070-020-02184-2.

    PMID: 36452777
  11. 11

    Pediatric laryngeal cleft repair and dysphagia.

    Wertz A, Ha JF, Driver LE, Zopf DA

    International journal of pediatric otorhinolaryngology 2018; (104()):216-219 doi:10.1016/j.ijporl.2017.11.017.

    PMID: 29287871
  12. 12

    Prevalence of dysphagia following posterior fossa tumour resection in children: the Alder Hey experience.

    Wright SH, Blumenow W, Kumar R, et al.

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2023; (39(3)):609-616 doi:10.1007/s00381-022-05774-3.

    PMID: 36512048
  13. 13

    Prevalence of Laryngeal Cleft in Pediatric Patients With Esophageal Atresia.

    Londahl M, Irace AL, Kawai K, et al.

    JAMA otolaryngology-- head & neck surgery 2018; (144(2)):164-168 doi:10.1001/jamaoto.2017.2682.

    PMID: 29270628

This page provides an introductory overview of laryngeal clefts for educational purposes. Always consult your child's pediatric ENT or multidisciplinary care team for an accurate diagnosis and treatment plan.

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