Abstract
Impaired laryngeal protective function can result in intractable aspiration. Surgery to separate the upper digestive tract from the respiratory tract is often necessary in cases of intractable aspiration to prevent recurrent bronchopulmonary contamination and resultant complications, including death. The common surgical techniques for the prevention of intractable aspiration are presented. The results of each procedure for aspiration prevention and reversibility are compared. The advantages and disadvantages of each surgical technique are discussed.
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Awe WC, Fletcher WS, Jacob SW: The pathophysiology of aspiration pneumonitis.Surgery 60:232–239, 1966
Bartlett JG, Gorbach SL: The triple threat of aspiration pneumonia.Chest 68:560–566, 1975
Cameron JS, Mitchell WH, Zuidema GD: Aspiration pneumonia: clinical outcomes following documented aspiration.Arch Surg 106:49–52, 1973
Huxley EJ, Viroslav J, Gray WR, Pierce AK: Pharyngeal aspiration in normal adults and patients with depressed consciousness.Am J Med 64:564–568, 1978
Alessi DM, Berci G: Aspiration and nasogastric intubation.Otolaryngol Head Neck Surg 94:486–489, 1986
Elpern EL, Jacobs ER, Bone RC: Incidence of aspiration in tracheally intubated adults.Heart Lung 16:527–531, 1987
Hassett JM, Sunby C, Flint LM: No climination of aspiration pneumonia in neurologically disabled patients with feeding gastrostomy.Surg Gynecol Obstet 167:383–388, 1988
Cameron JL, Reynolds J, Zuidema GD: Aspiration in patients with tracheostomies. Surg Gynecol Obstet 136:68–70, 1973
Bone DK, Davis JL, Zuidema GD, Cameron JL: Aspiration pneumonia: prevention of aspiration in patients with tracheostomies.Ann Thorac Surg 18:30–37, 1974
Bonanno PC: Swallowing dysfunction after tracheostomy.Ann Surg 174:29–33, 1971
Feldman SA, Deal CW, Urquhart W: Disturbance of swallowing after tracheostomy.Lancet 1:954–955, 1966
Nash M: Swallowing problems in the tracheotomized patient.Otolaryngol Clin North Am 21:702–709, 1988
Blitzer A: Evaluation and management of chronic aspiration.NY State J Med 87:154–160, 1987
Sasaki CT Suzuki M, Horiuchi M, Kirchner JA: The effect of tracheostomy on the laryngeal closure reflex.Laryngoscope 87:1428–1433, 1977
Pavlin EG, VanNimwegan D, Hornbein TF: Failure of a high-compliance low-pressure cuff to prevent aspiration.Anesthesiology 42:216–219, 1975
Bernhard WN, Cottrell JE, Sivakumaran C et al.: Adjustment of intracuff pressure to prevent aspiration.Anesthesiology 50:363–366, 1979
Petring OU, Adelhoj B, Jensen BN, et al: Prevention of silent aspiration due to leaks around cuffs of endotracheal tubes.Anesth Analg 65:777–780, 1986
Lewy RB: Glottic rehabilitation with Teflon injection—the return of voice, cough, and laughter.Acta Otolaryngol 58: 214–222, 1964
Yarington CT Jr, Harned R: Polytef (Teflon) injection for postoperative deglutition problems.Arch Otolaryngol 194:274–275, 1971
Rontal E, Rontal M, Morse G, Brown EL: Vocal cord injection in the treatment of acute and chronic aspiration.Laryngoscope 86:625–634, 1976
Ward PM, Manson DG, Abemayor E: Transcutaneous Teflon injection of the paralyzed vocal cord. A new technique.Laryngoscope 95:644–649, 1985
McCaffrey TB, Lipton R: Transcutaneous Teflon injection for paralytic dysphonia.Laryngoscope 99:497–499, 1989
Schramm VL, May M, Lavorato AS: Gelfoam past injection for vocal cord paralysis: temporary rehabilitation of glottic competence.Laryngoscope 88:1268–1273, 1978
Isshiki N, Okamura H, Ishikawa T: Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy.Acta Otolaryngol 80:465–473, 1975
Kaufman JA: Laryngoplasty for vocal cord medialization: an alternative to Teflon.Laryngoscope 96:726–731, 1986
Eisele DW, Yarington CT, Lindeman RC: Indications for the tracheoesophageal diversion procedure and the laryngotracheal separation procedure.Ann Otol Rhinol Laryngol 97:471–475, 1988
Briant TDR: Spontaneous pharyngeal fistula and wound infection following laryngectomy.Laryngoscope 85:829–834, 1975
Cannon CR, McLean WC: Laryngectomy for chronic aspiration.Am J Otolaryngol 3:145–149, 1982
Hawthorne M, Gray R, Cottam C: Conservative laryngectomy (an effective treatment for severe aspiration in motor neurone disease).J Laryngol Otol 101:283–285, 1987
Weisberger EC, Huebsch SA: Endoscopic treatment of aspiration using a laryngeal stent.Otolaryngol Head Neck Surg 90:215–222, 1982
Eliachar I, Roberts JK, Hayes JD, Tucker HM: A vented laryngeal stent with phonatory and pressure relief capability.Laryngoscope 97:1264–1269, 1987
Tucker HM: Management of the patient with an incompetent larynx.Am J Otolaryngol 1:47–56, 1979
Kirchner JC, Sasaki CT: Surgery for aspiration.Otolaryngol Clinic North Am 17:49–56, 1984
Blitzer A, Krespi YP, Oppenheimer RW, Levine TM: Surgical management of aspiration.Otolaryngol Clin North Am 21:743–750, 1988
Habal MB, Murray JE: Surgical treatment of life-endangering chronic aspiration pneumonia: use of an epiglottic flap to the arytenoids.Plast Reconstr Surg 49:305–311, 1972
Strome M, Fried MP: Rehabilitative surgery for aspiration.Arch Otolaryngol Head Neck Surg 109:809–811, 1983
Vecchione TR, Habel MB, Murray JE: Further experiences with the arytenoid-epiglottic flap for chronic aspiration pneumonia.Plast Reconstr Surg 55:318–323, 1975
Brooks GB, McKelvie P: Epiglottopexy: a new surgical technique to prevent intractable aspiration.Ann Coll Surg Engl 65:293–296, 1983
Warwick-Brown NP, Richards AES, Cheesman AD: Epiglottopexy: a modification using additional hyoid suspension.Laryngol Otol 100:1155–1158, 1986
Laurian N, Shvili Y, Zohar Y: Epiglotto-aryepiglottopexy: a surgical procedure for severe aspiration.Laryngoscope 96: 78–81, 1986
Biller HF, Lawson W, Baek SM: Total glossectomy: a technique of reconstruction eliminating laryngectomy.Arch Otolaryngol 109:69–73, 1983
Montgomery WW: Surgery to prevent aspiration.Arch Otolaryngol Head Neck Surg 101:679–682, 1975
Sasaki CT, Milmoe G, Yanagisawa E, et al: Surgical closure of the larynx for intractable aspiration.Arch Otolaryngol Head Neck Surg 106:422–423, 1980
Lulenski GC: Laryngeal closure and glottic reconstruction.Ear Nose Throat J 59:23–30, 1980
Lindeman RC: Diverting the paralyzed larynx: a reversible procedure for intractable aspiration.Laryngoscope 85:157–180, 1975
Lindeman RC, Yarington CT, Sutton D: Clinical experience with the tracheoesophageal anastomosis for intractable aspiration.Ann Otol Rhinol Laryngol 85:609–612, 1976
Krespi YP, Quatela VC, Sisson GA: Modified tracheoesophageal diversion for chronic aspiration.Laryngoscope 94:1298–1301, 1984
Baron BC, Dedo HH: Separation of the larynx and trachea for intractable aspiration.Laryngoscope 90:1927–1932, 1980
Butcher RB: Treatment of chronic aspiration as a complication of cerebrovascular accident.Laryngoscope 92:681–685, 1982
Gilbert RW, Bryce DP, McIlwain JC, Ross IR: Management of patients with long-term tracheotomies and aspiration.Ann Otol Rhinol Laryngol 96:561–564, 1987
Snyderman CH, Johnson JT: Laryngotracheal separation for intractable aspiration.Ann Otol Rhinol Laryngol 97:466–470, 1988
Eisele DW, Yarington CT, Lindeman RC, Larrabee WF: The tracheoesophageal diversion and laryngotracheal separation procedures for treatment of intractable aspiration.Am J Surg 157:230–236, 1989
Hillel AD: Personal communication, 1990
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Eisele, D.W. Surgical approaches to aspiration. Dysphagia 6, 71–78 (1991). https://doi.org/10.1007/BF02493482
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DOI: https://doi.org/10.1007/BF02493482