People with severe intellectual and motor disabilities often develop aspiration pneumonia due to swallowing dysfunction. The risk of aspiration pneumonia remains high even after gastrostomy because of concomitant gastroesophageal reflux disease in these individuals. They as well as their families are also annoyed with the need for frequent suctioning of sputum. When conservative and medical therapies are ineffective for controlling aspiration pneumonia, laryngotracheal separation is an option. After this procedure, the need for sputum suctioning may decrease. In Japan, a quarter of people in facilities for severe intellectual and motor disabilities have undergone gastrostomy. When gastrostomy is planned, laryngotracheal separation should also be considered, if possible. However, the rate of food-swallowing acquisition after laryngotracheal separation is reportedly lower in people with severe intellectual and motor disabilities than in those with cerebrovascular disorders or pharyngeal cancer. This difference may depend on a number of disease characteristics as well as the patient’s strength of will. Laryngotracheal separation should be performed with a thorough understanding of the cause, condition and course of a given patient’s intellectual and motor disabilities. In this review, the indications and complications of laryngotracheal separation are presented, along with illustrations of various operation methods.
