Evaluation of Surgical Closure of the Larynx for Intractable Aspiration

Abstract

Surgical closure of the larynx is a very effective treatment for intractable aspiration due to cerebrovascular disorders or progressive neuromuscular disease. We performed the glottic closure procedure with removal of both thyroid and cricoid cartilage and insertion of a sternohyoid muscle flap on 20 patients (15 male, 5 female ; median age of 68.5 years) between March 2010 and July 2014. In all cases, surgery was safely performed under general anesthesia, although the preoperative physical status was severe (ASA class 3) in 12 of the 20 patients. Closure of the larynx was achieved in all cases and no surgical site infection was observed. Fifteen of the 20 cases did not require any tracheal cannula. Stoma stenosis or mismatch between stoma and tracheal cannula occurred in 3 cases, for which stomaplasty was performed. The frequency of sucking sputum markedly decreased in 7 cases that had undergone tracheostomy before this procedure. In conclusion, the glottic closure procedure is a safe and secure approach for patients with intractable aspiration, and it is applicable even in those in severe physical condition. Size adjustment between the tracheostoma and the cannula is necessary in patients who require a ventilator.