Evaluation and management of a laryngeal cleft

14-month-old infant with a history of mild intermittent stridor, regurgitation, and wet "raspy" breathing.
(A) The chest radiograph shows mild perihilar opacities consistent with bronchial inflammation.
(B) FEES demonstrates mild laryngomalacia and aspiration of thin liquids through the interarytenoid space. VFSS (not shown) demonstrated a single episode of penetration.
(C) On rigid microlaryngoscopy and bronchoscopy, a type 1 laryngotracheoesophageal cleft was diagnosed. Bronchoalveolar lavage revealed lower airway inflammation and moderately positive pepsin.
(D) Endoscopic view of the laryngeal cleft after endoscopic repair with supraglottoplasty. The infant's symptoms subsequently resolved, and swallow studies normalized.