Diagnosis

Diagnosis Overview Aspiration Tests Swallow Study FEES Test Rigid Scope Triple Scope Flexible Scope

Rigid Scope

“Examining the larynx and upper airway under general anesthesia using a rigid scope is the current gold standard procedure used to diagnose a laryngeal cleft. ”

Formally, a rigid scope is typically called:

  • Direct Laryngoscopy and Bronchoscopy (DLB); or

  • Microscopic Laryngoscopy and Bronchoscopy (ML&B).

During a DLB/ML&B, an ENT gently inserts a rigid laryngoscope into the larynx and then a rigid bronchoscope into the trachea to view these organs. If a laryngeal cleft is present, the rigid scope allows it to be seen and the depth/type to be assessed. Signs of aspiration may also be seen, as well as other related abnormalities, such as different types of airway malacia or subglottic stenosis.

Redundant Mucosa

Sometimes, instead of a lack of tissue in the cleft area, there is extra tissue, commonly referred to as “redundant mucosa.” This tissue can obscure a laryngeal cleft, making the diagnosis difficult. During a rigid scope, it is important for the tissue to also be palpated with a probe in case redundant mucosa is hiding a cleft.

Close-up view of a type 3 laryngeal cleft.

A type 3 laryngeal cleft during a DLB.

DLB or ML&B

Location: Operating room

Advantages:

  • Able to fully view and probe the potential cleft area and upper airway.

  • Able to assess a cleft depth/type.

  • Other airway abnormalities may be seen and diagnosed.

  • Patient is asleep so there is no discomfort during the procedure.

  • Usually well tolerated by the patient.

Disadvantages:

  • Must be performed in the operating room using general anesthesia.

  • After the procedure, swelling/discomfort may occur and sometimes requires an overnight hospital stay for breathing observation.

  • A sore throat lasting a day or two is common.

  • Other risks exist and other complications may occur.