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.
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