Abstract
There are several procedures to prevent intractable aspiration, however, most such patients with aspiration still tend to have severe complications and thus are considered to show a poor risk for aggressive surgery. As a result, minimally invasive and more reliable procedures are thus required for such cases. We introduced a modified procedure of the technique of Montgomery. The frontal neck skin is incised vertically. The thyroid cartilage perichondrium is incised in the midline and then retracted widelyon both sides. Next, the anterior thyroid lamina is removed at the crico-thyroid joint. After the laryngeal lumen is opened by a laryngofissure, the glottis is denuded of the epithelium circumferentially at the level of the false vocal cord from the petiole of the epiglottis to the interarytenoid mucosa. The petiole and interarytenoid mucosa are sutured in an anterior-posterior direction and then the laryngofissure is closed with strap muscles. The patient was a 66-year-old male who complained of intractable aspiration of refluxed bile due to a gastrectomy and medullary infarction. He was transferred to our hospital to undergo surgery that would correct the troublesome aspiration. However, his preoperative condition continued to worsen, with an unabated flow of emesis into his lungs and he therefore developed severe respiratory failure. General anesthesia was difficult to administer, and therefore we performed a supraglottic closure under local anesthesia. After surgery, his general condition rapidly improved, and he was able to be transferred to a rehabilitation facility without any major post-operative complications. This procedure is therefore considered to be useful for the patients without the need to perform a reverse operation due to presence of underlying intractable or progressive diseases.
