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Laryngeal Diversion Procedures

  • William E. Karle
  • Joshua S. SchindlerEmail author
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Abstract

Laryngeal diversion procedures are used for patients with intractable aspiration. These surgeries include laryngotracheal separation (LTS) and tracheoesophageal diversion (TED). Both procedures are potentially reversible and offer an alternative to a near-field laryngectomy (NFL).

Laryngeal diversion surgery prevents aspiration, avoids negatively affecting deglutition, and provides a safe airway. However, the most commonly performed surgery for intractable aspiration is the NFL. The main alternatives to a NFL are a LTS or TED. Both of these procedures have the potential to be reversed and have shorter operative times compared to aNFL. When performing a LTS, a tracheostoma is created in a similar fashion to a TL, but the larynx is left in situ. Instead, the first couple of rings remain attached to the larynx are closed to create a blind pouch.

A variation to a laryngotracheal separation is a tracheoesophageal diversion. Instead of creating a blind pouch, the most proximal tracheal rings are sutured end-to-side with the cervical esophagus. A TED provides a longer proximal tracheal segment and avoids resection of any tracheal rings, making an easier airway reconstitution in the rare event that a reversal is warranted. Although a laryngeal diversion may be a lifesaving surgery for certain patients, the morbidity associated with it is significant as it will leave the patient aphonic.

Keywords

Laryngeal diversion Aspiration Near-field laryngectomy Laryngotracheal separation Tracheoesophageal diversion Glottic closure Supraglottic closure Epiglottic flap Airway Salivary leak 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Otolaryngology–Head & Neck SurgeryMayo ClinicPhoenixUSA
  2. 2.Department of Otolaryngology-Head & Neck SurgeryOregon Health & Science University (OHSU), Northwest Clinic for Voice and SwallowingPortlandUSA

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