CASE REPORT The utility of the fiberoptic endoscopic evaluation of swallowing (FEES) in diagnosing and treating children with Type I laryngeal clefts Mark E. Boseley a, * , Jean Ashland b , Christopher J. Hartnick a a Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, 243 Charles Street, Boston, MA 02114-3914, USA b Department of Speech Language Pathology, Massachusetts General Hospital for Children, Boston, MA, USA Received 31 March 2005; accepted 24 June 2005 1. Introduction The first case of a laryngeal cleft was reported by Richter in 1792 [1]. Since that report, only a few cases have documented. Incidence is estimated at 0.1% of the population [2]. Most cases found as isolated occurrences are believed to occur sporadi- cally, although familial inheritance has been docu- mented in three families [2]. Associated findings in order from most to least common are tracheoeso- phageal fistulas, laryngomalacia, cleft lip and palate, subglottic stenosis, pulmonary abnormal- ities, cardiac defects, hamartomas, gastrointestinal abnormalities, and genitourinary abnormalities [2]. Clinicians should be aware of two syndromes, Pallister Hall and Opitz BBB or G syndrome, when forming differential diagnoses in children suspected of having laryngeal clefts. Pallister Hall Syndrome has associated findings of hypothalmic hamarblas- toma, hypopituitarism, imperforate anus, and polydactyly. This syndrome is associated with abnormalities in the GLI-Kruppel family member 3 International Journal of Pediatric Otorhinolaryngology (2006) 70, 339—343 www.elsevier.com/locate/ijporl KEYWORDS Laryngeal cleft; Aspiration; Fiberoptic endoscopic evaluation of swallowing (FEES) Summary This case series of three young children with type I laryngeal clefts is presented to demonstrate the utility of fiberoptic endoscopic evaluation of swallow- ing (FEES) in managing these patients. FEES revealed laryngeal penetration in a posterior to anterior direction in two patients and penetration from lateral to medial in the third patient. The type of laryngeal penetration helped in making the diagnosis of a type I cleft in two children and helped establish a safe feeding regiment in the third child. Patients with type I laryngeal clefts are often misdiagnosed, most likely resulting from the complex presentation of signs/symptoms and the difficulty of detecting small clefts with currently available tests. The pattern of laryngeal aspiration seen with FEES can help in diagnosis and management in this patient population. Published by Elsevier Ireland Ltd. * Corresponding author. Tel.: +1 617 573 4206. E-mail addresses: M.Boseley@att.net (M.E. Boseley), Christopher_hartnick@meei.harvard.edu (C.J. Hartnick). 0165-5876/$ — see front matter. Published by Elsevier Ireland Ltd. doi:10.1016/j.ijporl.2005.06.026