Simple and new surgical procedure for laryngotracheal separation in pediatrics.
OBJECTIVE
In children with severe physical and mental disabilities who repeatedly develop aspiration pneumonia due to intractable aspiration, laryngotracheal separation/tracheoesophageal anastomosis or laryngotracheal separation has been performed in many institutions for the prevention of aspiration, and good results have been reported. However, families sometimes show a marked reluctance to give consent to these surgical techniques because of tracheal transection. A purpose of this study is to evaluate a new surgical procedure for laryngotracheal separation without tracheal transection.


METHODS
Case-series study.


METHODS
As a new, simple, less invasive surgical technique for the prevention of aspiration without tracheal transection, we performed tracheal closure (tracheal flap method) in six children. A U-shaped flap of the tracheal anterior wall from the 2nd to the 4th/5th tracheal ring was produced, bent toward the tracheal lumen, and sutured to the tracheal posterior/lateral walls by mattress stitches for tracheal closure. In addition, the closure was covered with a cutaneous U-shaped flap for reinforcement and a permanent tracheal stoma was constructed.


RESULTS
In all six patients, aspiration pneumonia could be prevented without severe complications.


CONCLUSIONS
Tracheal closure (tracheal flap method) has effects comparable to those of other surgical techniques for the prevention of aspiration, and may be useful for aspiration prevention in children with severe physical and mental disabilities.
Ninomiya
Hiroshi
H
Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan. hnino@med.gunma-u.ac.jp
Yasuoka
Yoshihito
Y
Inoue
Yoshihiro
Y
Toyoda
Minoru
M
Takahashi
Katsumasa
K
Miyashita
Motoaki
M
Furuya
Nobuhiko
N
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D013524:Surgical Flaps; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome