During the period between 2005 and 2011, 13 patients (4 male and 9 female) with severe motor and intellectual disabilities underwent surgical intervention to prevent intractable aspiration. We evaluated the surgical results and postoperative conditions of these patients. The average age was 10 years and 10 months, with an age range from 1 year and 11 months to 20 years and 11 months. Laryngotracheal separation (LTS) was performed in 8 patients, total laryngectomy in 3 patients, tracheoesophageal anastomosis (TEA) in 1 patient, and laryngeal closure in 1 patient. The average duration of surgery was 124 minutes for LTS or TEA (9 patients) and 148 minutes for total laryngectomy (3 patients). There was no significant difference between the two groups. The average blood loss during LTS or TEA was less than that for total laryngectomy. Postoperative complications were tracheocutaneous fistula in one patient, narrowing of the tracheostomy site in one patient, and a tracheo-innominate artery fistula that caused fatal bleeding in one patient. Tracheocutaneous fistula was treated conservatively, and the fistula was successfully closed. Additional surgery was performed to enlarge the tracheal stoma in the patient with narrowing of the tracheostomy site. Unfortunately, the patient with the tracheo-innominate artery fistula died. Scores of incidences of aspiration pneumonia reflect the frequency of occurrence. Aspiration pneumonia scores after surgery were significantly better than the scores before surgery, indicating that surgical therapy for severe motor and intellectual disabilities with intractable aspiration is effective. Surgical management for intractable aspiration should be performed at appropriate times, considering the underlying disease and age.
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