Abstract
Biller's technique (1983) of laryngoplasty is useful for the management of chronic intractable aspiration. The posterior part of the glottis completely closes, not at the glottis, but at the supraglottis. The bilateral arytenoids come into contact at the superior portion of the arytenoid cartilage from the vocal process to the apex. We introduced surgical closure of the larynx for intractable aspiration using this anatomical feature of the posterior glottis in combination with Biller's technique.
The operation procedure is as follows. A suprahyoid-pharyngotomy is performed. To close the posterior glottis, dissection of the mucosa over the superior portion of the arytenoid cartilages from the vocal process to the apex and the interarytenoid notch is performed. The medial mucosal flap, bilateral arytenoid cartilages and lateral mucosal flaps are sutured together at the midline. To close the supraglottis, an incision is made on either side of the arytenoids and aryepiglottic folds. The medial mucosal flaps, the lmina propria of the mucosa and lateral mucosal flap are sutured together at the midline. An incision is made on either side of the lateral border of the epiglottis. The medial mucosal flaps, epiglottic cartilage and the lateral mucosal flaps are sutured at the midline. The suture is closed completely, except for a small openirlg at the top of the epiglottis.
This method archived complete closure of the posterior part of the larynx, thus it securely prevented aspiration. This procedure is a reliable method of closing the larynx that permits retention of the larynx with preservation of swallowing and phonation.
