Abstract
We report a case of severe dysphagia treated by central-part laryngectomy （CPL） under local anesthesia. An 89-year-old woman presented with a chief complaint of progressive dysphagia. In July X-1, she had undergone intubation and tracheotomy for CO2 narcosis. Subsequently, she was hospitalized three times owing to aspiration pneumonia. She was transferred to our hospital, and expressed a desire for oral intake despite her progressive dysphagia. A videofluoroscopic swallowing study revealed that her upper esophageal sphincter was completely stenosed. We expected that oral intake would be possible after typical surgical intervention for intractable aspiration, such as total laryngectomy or larynx-trachea separation surgery.
After discussion with an anesthesiologist and pulmonologist, we concluded that general anesthesia was prohibitively risky for her owing to her ventilator dependence, hypercapnia, and advanced age. We therefore performed an operation under local anesthesia. Continuous intravenous infusion of pentazocine and hydroxyzine was used for sedation, and local anesthesia was achieved using subcutaneous injection of lidocaine with 1％ epinephrine. We then successfully performed typical CPL and reconstructed her tracheostoma at the height of the first tracheal ring. Postoperatively, the patient recovered well without major complications, and she became able to ingest food orally and completely.
We conclude that for patients whose comorbid conditions preclude general anesthesia, CPL under local anesthesia alone can be considered.
