laryngeal cleft is a rare malformation involving the larynx (known as the voice box) and the esophagus (known as the food pipe). Normally, when the larynx develops, it is completely separate from the esophagus so that swallowed foods travel directly through the esophagus into the stomach. A laryngeal cleft occurs when these structures do not develop normally in an embryo, and there is an opening connecting the larynx (and sometimes trachea) and the esophagus. This enables food and liquid that is swallowed to pass through the opening to the larynx, and into the lungs. Signs and symptoms may appear in the first few months of life and may include feeding problems, trouble swallowing, failure to thrive, reflux, coughing, wheezing, stridor, aspiration, respiratory distress, and recurrent lung infections. There are several different types of laryngeal clefts (types I through IV), which are classified based on the specific location and extent (severity) of the cleft.

A cleft can occur as an isolated abnormality, as part of an underlying syndrome or condition (such as Opitz-Frias, VACTERL, Pallister-Hall, CHARGE), or with other associated malformations. Treatment depends on the location and severity of the cleft and symptoms. For example, small clefts can sometimes be managed with medications to control symptoms such as reflux or aspiration, while some smaller clefts and larger clefts may need to be treated with endoscopic procedures or surgery.

• Type I clefts are the mildest; in this type the cleft (opening) between the larynx and the esophagus is located above the vocal cords. This type may not be diagnosed immediately (sometimes not until age 5), and in an otherwise healthy child it may not cause significant symptoms.
• Type II clefts extend into the lower cartilage of the voice box, below the vocal chords.
• Type III clefts extend beyond the voice box and into the trachea (windpipe).
• Type IV clefts are the most severe, with the cleft extending even further down into the trachea (sometimes all the way to the bottom).

Initial symptoms of a laryngeal cleft may include coughing (especially with feeding), feeding difficulties, and some degree of respiratory distress (depending on the depth of the cleft). Other signs and symptoms may include aspiration, recurrent lung infections, stridor, wheezing, failure to thrive, and cyanosis (particularly in those with other underlying health problems or malformations).[ Type III and IV clefts are associated with more severe respiratory symptoms, recurrent pneumonia, and excessive mucous in the lungs. Types III and IV usually become apparent within the first few days of life.

The best treatment for a laryngeal cleft depends on the type of cleft and the severity of the symptoms it causes. In some cases, minor clefts (particularly types I or II) can be managed with medications that treat or prevent symptoms such as reflux or aspiration. Type I clefts may correct themselves as a person grows. A smaller-sized cleft that requires additional treatment may be treated with endoscopic repair. More severe clefts (particularly types III and IV) often require endocopic procedures or surgery.