title: [Successful total laryngectomy in three cases with severe motor and intellectual disabilities syndrome for the management of repetitive lower respiratory tract infections].
abstract: Total laryngectomy was successfully performed for the management of repetitive lower respiratory tract infections in three cases with severe motor and intellectual disabilities syndrome. The patients were thirteen, ten and nine years of age and had cerebral palsy, mental retardation and epilepsy which resulted from neonatal asphyxia and seizures. To treat repetitive lower respiratory tract infections, the patients underwent the operation at the age of nine years and a month, seven years and six months, and six years and eleven months, respectively. Postoperatively, the respiratory tract infections were remarkably reduced for two to four years. Total laryngectomy is one of the best methods for the prevention of aspiration pneumonia, because it separates trachea and esophagus completely. The operation is indicated for children with influx of saliva into trachea and gastroesophageal reflux. The family should recognize that this operation causes permanent loss of voice and speech. The bronchoscopy, upper gastrointestinal tract barium studies and esophageal pH monitoring should be performed before the operation. Our cases fulfilled all of these indications. Laryngectomy should be considered as an effective method of respiratory management for cases of severe motor and intellectual disabilities syndrome, although its application should be carefully examined from the point of improvement of quality of life for patients.
authors.affiliation: Department of Pediatrics, Kitasato University School of Medicine, Kanagawa.
authors.forename: F
authors.initials: F
authors.lastname: Katayama
authors.forename: H
authors.initials: H
authors.lastname: Miura
authors.forename: W
authors.initials: W
authors.lastname: Sunaoshi
authors.forename: T
authors.initials: T
authors.lastname: Sekine
authors.forename: K
authors.initials: K
authors.lastname: Takei
authors.forename: M
authors.initials: M
authors.lastname: Umehara
authors.forename: M
authors.initials: M
authors.lastname: Hirayama
mesh_terms: D000293:Adolescent; D002648:Child; D019988:Children with Disabilities; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007825:Laryngectomy; D008297:Male; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome