674 A Rare Cause of Dysphagia in an Adult: Laryngeal Cleft, a Case Report from a Tertiary Care Centre

Abstract Introduction Laryngeal cleft is a rare congenital anomaly where the laryngotracheal wall fails to fuse posteriorly resulting in a gap. Embryologically, larynx develops from IV and VI branchial arches and is separated from foregut by trachea-esophageal septum, which closes from caudal to cranial end. Symptoms can vary, depending on where these fusion arrests, from none in mild cases to aspiration, recurrent pneumonia, dysphagia, and hoarseness of voice in severe. The condition is almost always detected in childhood and rarely diagnosed in adults. Method We present a case of 41-year-old male with dysphagia and choking episodes, having previously been treated for cleft palate and larynx as a child alongside a literature review of such published cases. Results A 41-year-old male developed swallowing problems with choking episodes on a background of having had a successful repair of a type 3 cleft in childhood. He underwent video fluoroscopy which demonstrated evidence of aspiration. He subsequently underwent a diagnostic microlaryngoscopy, which disclosed a type III laryngeal cleft. He was treated surgically with open laryngeal cleft repair, following which the postoperative fibreoptic endoscopic evaluation of swallowing demonstrated strong swallow. He was discharged home on successful resumption of his baseline diet. Conclusion Laryngeal clefts in adults are very rare and can be successfully treated surgically. The case report showcases the condition can still present in adult life with late failure (breakdown) and the need for awareness about the disorder. A review revealed very few reported adult cases in the current literature.