# Laryngeal Cleft — GCMD Library living collection

Everything in the library about laryngeal cleft — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 31 cited statements

## Episodes
### Medical Management
- [QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773) — video · 7:11 · [machine version](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773.md)

### Surgical Management
- [Laryngeal Clefts](https://library.globalcastmd.com/watch/laryngeal-clefts-4226) — video · 14:20 · [machine version](https://library.globalcastmd.com/watch/laryngeal-clefts-4226.md)
- [QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373) — video · 6:01 · [machine version](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=0) Introduction to laryngeal clefts and classification systems (Ep 1)
- [1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101) Diagnostic challenges and the inadequacy of flexible bronchoscopy (Ep 1)
- [3:43](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=223) Endoscopic repair technique using laser and sutures (Ep 1)
- [7:00](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=420) Open transtracheal repair for severe clefts (Ep 1)
- [9:59](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=599) Case examples: type 4 long cleft and tracheoesophageal fistula (Ep 1)
- [13:43](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=823) Closing remarks and course announcement (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=0) Introduction and Diagnostic Challenge of Laryngeal Clefts (Ep 2)
- [1:19](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=79) Surgical Indications and Endoscopic Technique Overview (Ep 2)
- [2:04](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=124) Step-by-Step Surgical Technique and Postoperative Care (Ep 2)
- [3:29](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=209) Failure Modes, Comparative Outcomes, and Consensus Guidelines (Ep 2)
- [5:04](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=304) Summary and Closing (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=0) Introduction and Conference Context (Ep 3)
- [0:40](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=40) Case Presentation and Bronchoscopic Findings (Ep 3)
- [1:52](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=112) Assessment Framework for Cleft Management (Ep 3)
- [3:42](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=222) Medical Management Strategies (Ep 3)
- [4:49](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=289) Pulmonary Therapies and Health Maintenance (Ep 3)
- [5:54](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=354) Monitoring Strategy and Summary (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "A laryngeal cleft is a congenital condition in which the posterior wall of the laryngotracheal tract is open and food or liquids can pass from the esophagus into the trachea, leading to aspirations." — Michael Rutter (host_summary) [Ep 1 · 0:59](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=59)
- "Type 1 laryngeal cleft means the opening is above the vocal cords." — Rod Gerardo (host_summary) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "Type 2 laryngeal cleft means it extends below the vocal cords." — Rod Gerardo (host_summary) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "Type 3 laryngeal cleft means it extends down into the trachea." — Rod Gerardo (host_summary) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "The Benjamin Inglis classification should be modified to include a type 4 long because type 4 could be proximal above the carina, at the carina, or go straight through the carina." — Rod Gerardo (host_summary) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "Flexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft." — Rod Gerardo (host_summary) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "The mass closure technique developed in Cincinnati uses the same concept as endoscopic tracheoesophageal fistula repair: you want raw against raw, with wide strips of raw tissue opposed after removing the non-stick mucosal surface." — Rod Gerardo (host_summary) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "KTP laser or CO2 laser can be used for broad mucosal removal in laryngeal cleft repair, and using laser is easier to use and easier to teach with." — Alessandro Dialicon (clinical) [Ep 1 · 3:43](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=223)
- "Open approach for laryngeal clefts is reserved for failed endoscopic repair cases, some type 2s and type 3s, using a laryngofissure approach." — Michael Rutter (host_summary) [Ep 1 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "For type 4 clefts, a cervical approach is used." — Michael Rutter (host_summary) [Ep 1 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "Type 4 long clefts present anesthetic challenges requiring double lumen tube, single lung ventilation, ECMO or bypass, and often have associated microgastria and multiple congenital anomalies." — Michael Rutter (host_summary) [Ep 1 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "Type 4 long clefts have a very high mortality rate of approximately 50%." — Michael Rutter (host_summary) [Ep 1 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "The Cincinnati team does not distinguish between anatomical type 1 cleft versus deep notch for treatment decisions; they care whether the patient is aspirating (physiological cleft)." — Michael Rutter (host_summary) [Ep 1 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "Most type 3 clefts are attempted endoscopically unless there is a reason to go open." — Michael Rutter (host_summary) [Ep 1 · 7:04](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=424)
- "The transtracheal technique for type 4 clefts involves forming layers between trachea and esophagus, sewing the esophageal layer with knots in lumen, sewing the tracheal layer with knots in lumen, with optional interposition graft." — Michael Rutter (host_summary) [Ep 1 · 7:04](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=424)
- "The novel surgical technique for type 4 long clefts involves transecting the trachea at the lower border of the cricoid, peeling the trachea off the esophagus beyond the cleft while keeping the patient intubated into one bronchus, repairing the esophagus with optional second imbricating layer, placing an interposition graft (typically sternal or tibial periosteum), reconnecting the trachea to the cricoid, and placing a tracheostomy relatively late at two or three weeks." — Michael Rutter (host_summary) [Ep 1 · 8:53](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=533)
- "For the type 4 long cleft case, the team waited three months until the child was greater than 5 kilograms based on outcomes data from previous research." — Michael Rutter (host_summary) [Ep 1 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "When placing an endotracheal tube for type 4 long cleft repair, think big, like 4.5 size." — Michael Rutter (host_summary) [Ep 1 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "The biggest risk with laryngotracheal esophageal clefts is that the distal end turns into a tracheoesophageal fistula." — Michael Rutter (host_summary) [Ep 1 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "Residual tracheoesophageal fistula can be repaired endoscopically using bugbee cautery to demucosalize the tract followed by endoscopic suture placement with P2 needle on 4-0 PDS to create raw-against-raw closure." — Michael Rutter (host_summary) [Ep 1 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "A type 1 laryngeal cleft can appear normal on flexible bronchoscopy but be visible on rigid bronchoscopy using less sophisticated identification techniques." — Katherine Hart (clinical) [Ep 2 · 0:48](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=48)
- "Combined flexible and rigid bronchoscopy evaluations are complementary and necessary to avoid missing laryngeal clefts." — Katherine Hart (clinical) [Ep 2 · 1:09](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=69)
- "Surgical indications for laryngeal cleft repair include ongoing respiratory symptoms, aspiration, failure to thrive, recurrent pulmonary infections, and failure of conservative measures (or in some instances before trying conservative measures)." — Katherine Hart (clinical) [Ep 2 · 1:22](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=82)
- "The goal of endoscopic cleft repair is to remove the interarytenoid mucosa to create two raw surfaces and then suture the edges together." — Em Gootee (host_summary) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=101)
- "Mass closure or layered closure technique can be used for laryngeal cleft repair, but the key requirement is that edges must be inverted when finished." — Katherine Hart (clinical) [Ep 2 · 1:52](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=112)
- "If suture bites are taken too deeply during cleft repair, edges will be inverted and the child will continue to have problems." — Em Gootee (host_summary) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=125)
- "Interarytenoid mucosa can be resected using laser or cold steel (knife), and the choice does not matter clinically." — Em Gootee (host_summary) [Ep 2 · 2:22](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=142)
- "Cold steel is preferred over laser for minor cleft resection because it is simpler to set up, faster, and eliminates the risk of laser fire." — Katherine Hart (opinion) [Ep 2 · 2:30](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=150)
- "Complete demucosalization of the apex is essential; if incomplete, a hole will remain at the apex and the child will continue to aspirate." — Em Gootee (host_summary) [Ep 2 · 2:42](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=162)
- "Closure is performed using interrupted sutures, typically PDS on an RB1 or P3 needle depending on child size." — Katherine Hart (clinical) [Ep 2 · 2:52](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=172)
- "Typically 2 to 3 sutures are placed depending on the extent of the cleft." — Em Gootee (host_summary) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=181)
- "Epiglottic folds are released after suturing to create extra space." — Em Gootee (host_summary) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=181)
- "Postoperatively, children are observed overnight on the airway unit and resume their preoperative diet, which is continued until postoperative evaluation." — Katherine Hart (clinical) [Ep 2 · 3:10](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=190)
- "Postoperative evaluation is typically performed 6 to 8 weeks after surgery and includes repeat video swallow study and repeat endoscopy to ensure healing." — Katherine Hart (clinical) [Ep 2 · 3:15](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=195)
- "Failure of endoscopic cleft repair is not super common." — Katherine Hart (clinical) [Ep 2 · 3:29](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=209)
- "Incomplete demucosalization at the apex can result in healing at the top but a gap remaining at the back." — Katherine Hart (clinical) [Ep 2 · 3:32](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=212)
- "Layered closure technique (closing anterior and posterior portions separately) seems like more effort in minor clefts but is a more reasonable option for type 2 or 3 clefts to ensure good closure." — Katherine Hart (opinion) [Ep 2 · 3:46](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=226)
- "Conservative management (not surgery) achieves resolution over time in 51% of children with laryngeal clefts." — Katherine Hart (epidemiological) [Ep 2 · 4:09](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=249)
- "Injection laryngoplasty achieves improvement in symptoms in two-thirds of children and resolution in one-third." — Katherine Hart (epidemiological) [Ep 2 · 4:24](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=264)
- "Surgical closure of laryngeal clefts achieves improvement in symptoms in almost 80% of children and resolution in 70%." — Em Gootee (host_summary) [Ep 2 · 4:31](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=271)
- "Surgical closure has a slightly higher risk of complications compared to conservative management." — Em Gootee (host_summary) [Ep 2 · 4:36](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=276)
- "Complications of surgical cleft repair are often not terrible but include reports of laryngeal scarring, supraglottic infections, and lacerations." — Katherine Hart (clinical) [Ep 2 · 4:45](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=285)
- "A consensus guideline exists for diagnosing and managing laryngeal clefts in children and is a good resource, especially for those newer to practice." — Em Gootee (host_summary) [Ep 2 · 4:54](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=294)
- "Flexible bronchoscopy is quite limited in evaluating a cleft unless it's a major cleft." — Em Gootee (host_summary) [Ep 3 · 0:54](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=54)
- "A deep interarytenoid notch is considered a minor cleft by Dr. Burg's team." — Em Gootee (host_summary) [Ep 3 · 1:13](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=73)
- "The case patient had a very inflammatory pattern on bronchoalveolar lavage but did not have lipid-laden macrophages despite being orally fed." — Greg Burg (clinical) [Ep 3 · 1:34](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=94)
- "Respiratory culture showed predominantly upper airway flora and two Candida species in the mucopurulent bronchitis." — Em Gootee (host_summary) [Ep 3 · 1:44](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=104)
- "Management of laryngeal clefts depends heavily on the degree of aspiration." — Greg Burg (clinical) [Ep 3 · 1:52](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=112)
- "Clinical assessment includes evaluating frequency of coughing, sick visits, emergency room visits, and hospitalizations." — Em Gootee (host_summary) [Ep 3 · 2:07](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=127)
- "Bronchoscopic assessment looks for airway edema, visibility of tracheal rings, mucus plugging, and secretions." — Em Gootee (host_summary) [Ep 3 · 2:15](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=135)
- "Patients with significant tracheobronchomalacia or upper airway obstruction from tonsils and adenoids may generate greater respiratory forces that push more air across the glottis and can increase aspiration risk." — Greg Burg (clinical) [Ep 3 · 2:34](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=154)
- "BAL analysis examines inflammatory cell types, culture results, and macrophage contents." — Greg Burg (clinical) [Ep 3 · 2:50](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=170)
- "Parental report of choking and coughing with water intake raises suspicion for a minor cleft." — Greg Burg (clinical) [Ep 3 · 3:05](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=185)
- "Chest CT is the most important differential imaging study, used to look for chronic changes related to aspiration." — Em Gootee (host_summary) [Ep 3 · 3:18](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=198)
- "A child with a deepened interarytenoid notch plus evidence of aspiration on BAL or other assessments plus bronchiectasis on imaging warrants consideration for surgical repair." — Greg Burg (clinical) [Ep 3 · 3:27](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=207)
- "For patients with an interarytenoid notch and genetic components with concern for central swallowing control, brain MRI may be checked to assess neurologic and functional comorbidities." — Greg Burg (clinical) [Ep 3 · 3:42](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=222)
- "Safe swallowing techniques include thickening, pacing, and volume modification." — Greg Burg (clinical) [Ep 3 · 4:04](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=244)
- "G-tubes and NG-tubes are used as needed for nutritional intake." — Em Gootee (host_summary) [Ep 3 · 4:12](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=252)
- "Aspiration can occur from three locations: things that start in the upper airway, things put in the upper airway, and things that come up from the GI system." — Greg Burg (clinical) [Ep 3 · 4:20](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=260)
- "Medical management addresses excessive drooling and esophageal or GI motility issues that increase vomiting and reflux aspiration risk." — Greg Burg (clinical) [Ep 3 · 4:29](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=269)
- "Pulmonary therapies are mostly considered reactive band-aids." — Greg Burg (opinion) [Ep 3 · 4:49](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=289)
- "Inhaled steroids may be tried to reduce inflammation." — Greg Burg (clinical) [Ep 3 · 4:54](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=294)
- "Chronic macrolide therapy can be used as an anti-neutrophilic agent, derived from cystic fibrosis literature." — Em Gootee (host_summary) [Ep 3 · 4:57](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=297)
- "Saline is used to thin out secretions." — Em Gootee (host_summary) [Ep 3 · 4:57](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=297)
- "Albuterol may be used for bronchodilation if there is a reactive airway component to aspiration pneumonitis." — Greg Burg (clinical) [Ep 3 · 5:06](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=306)
- "For patients with significant tracheomalacia, ipratropium may be used over albuterol." — Em Gootee (host_summary) [Ep 3 · 5:14](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=314)
- "Airway clearance augmentation is needed for neurodevelopmentally limited or musculoskeletally limited patients who lack effective cough or airway clearance ability." — Greg Burg (clinical) [Ep 3 · 5:19](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=319)
- "Health maintenance for aspiration-risk patients includes vaccination against respiratory illnesses and reducing environmental hazards including smoke exposure." — Greg Burg (clinical) [Ep 3 · 5:41](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=341)
- "For non-operative monitoring, pulmonologists track clinical symptoms, hospitalization frequency, response to interventions, and may repeat bronchoscopy and swallow assessments to guide further management." — Greg Burg (clinical) [Ep 3 · 5:54](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=354)

## Changelog
- Sep 7: 3 items added automatically

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