Management Strategies of Laryngeal Cleft Type 1: A Systematic Review and Network Meta-analysis

Purpose: The management of laryngeal cleft type-1 (LC-1) remains debated, with differing opinions on the efficacy and safety of Endoscopic division repair (EDR), injection laryngoplasty (IL), and conservative medical management (CMM). This review and network meta-analysis evaluated multiple treatment options to determine the most effective and safest approach. Methods: We conducted a database search on PubMed, Scopus, and Web of Science in the last 20 years (2004 to August 2024). PICOS criteria included LC-1 patients, any intervention (CMM, EDR, and IL), comparators (any other interventions or no comparison), outcomes (effectiveness including resolution or improvement and complications), and study designs (randomized controlled trials, cohort, case–control, and case series). Results: Seven studies with 376 patients were included for complete resolution, and 5 studies with 304 patients for improvement. Only EDR was associated with better complete resolution compared to IL (odds ratio [OR] = 8.08: 95% confidence interval [CI]: 1.36, 47.84) but not CMM. For symptom improvement, EDR showed superiority compared to both CMM (OR = 9.94, 95% CI: 1.07, 92.54) and IL (OR = 18.37; 95% CI: 2.25, 149.85). No significant differences were observed otherwise. Single-arm analysis showed resolution rates at 70.3%, 62.6%, and 42.2%, and improvement rates at 81.7%, 62.6%, and 60.4% for EDR, CMM, and IL, respectively, though with high heterogeneity. Sensitivity analysis, conducted by subgrouping techniques within each strategy, reduced heterogeneity. All treatment strategies were considered relatively safe. Conclusions: EDR provides better resolution and improvement in LC-1 patients, compared to CMM and IL. Further investigation is needed to assess the differential effectiveness of the different techniques within each treatment strategy.