Laryngeal clefts begin at the very top of the two tubes. Imagine a zipper unzipping, and you can understand how deep clefts can be. If the zipper unzips only to the level of the vocal cords, then it is a type 1 cleft. If the zipper unzips all the way down so there is a connection all the way down the two pipes, this is a type 4 cleft.
Type 2,3, and 4 clefts require surgical repair so that the child does not continue to aspirate (a condition in which food or liquid is trapped in the lungs) and develop chronic lung problems. Some children with type 1 clefts eventually outgrow them, so if they can managed on thickened feeds and are not getting pneumonia, often we wait until they are 2 or 3 before making a decision whether or not to operate.
The image above shows a popularized grading system for classifying the degree of severity of laryngeal cleft.
Laryngeal Cleft: This photograph represents a child with laryngeal cleft before surgery.
Postoperative Laryngeal Cleft: This photograph represents a child with laryngeal cleft after surgical repair.