2023 Volume 162 Pages 103-106
Many children with severe motor and intellectual disabilities require surgery to prevent aspiration due to swallowing dysfunction. However, severely mentally and physically handicapped children are at a high risk for the formation of tracheo-innominate artery fistulas, a fatal complication of tracheal cannula placement. Cricoid fenestration and surgical closure of the larynx with partial resection of the cricoid cartilage (Kano’s method), which is based on cricoid fenestration, allow the airway to be secured at the level of the larynx, avoiding proximity of the tracheal cannula to the innominate artery and preventing the development of tracheo-innominate artery fistulas. In this report, we describe a case of surgical closure of the larynx (Kano’s method) in a child with severe motor and intellectual disabilities who had undergone cricoid fenestration approximately 9 months previously. The patient was a 10-year-old girl with respiratory failure due to Fukuyama congenital muscular dystrophy, scoliosis and thoracic deformity. A tracheotomy was requested by the pediatric department for respiratory care, but cricoid fenestration was performed in view of the potentially high risk of formation of tracheo-innominate artery fistula. Thereafter, the patient developed repeated episodes of aspiration pneumonia, and about 9 months later, surgical closure of the larynx (Kano’s method) was performed. There was no granulation tissue or scarring due to the manipulation of the cricoid cartilage, and the surgery was performed without any complications. The procedure was effective for avoiding proximity between the tracheal cannula and innominate artery and preventing the formation of tracheo-innominate artery fistulas. We believe that staged surgical closure of the larynx (Kano’s method) after cricoid fenestration is a useful technique for the treatment of dysphagia in children with severe motor and intellectual disabilities.
