'Steam-boat' supraglottic laryngoplasty for treatment of chronic refractory aspiration: a modification of Biller's technique.
OBJECTIVE
The surgical treatment of intractable aspiration usually requires sacrifice of the patient's natural voice to prevent food entering the airway. Biller described a tubed supraglottic laryngoplasty to control aspiration while allowing patients to phonate with their larynx. Our preliminary experience with this technique in Chinese patients has been disappointing, as tension in the mucosa on wound closure led to wound dehiscence. Our objective was to modify Biller's technique in order to achieve a better outcome.


METHODS
We modified Biller's technique by trimming the epiglottic cartilage and by inserting a tibial periosteal graft to reinforce closure of the mucosa, creating an arrangement resembling a Chinese steam boat.


RESULTS
Three Chinese patients underwent the modified Biller's technique. No wound dehiscence occurred, the surgery controlled aspiration, and the patients were able to phonate with their own larynx. All patients resumed oral feeding, and previously placed gastrostomy tubes were removed.


CONCLUSIONS
The 'steam-boat' supraglottic laryngoplasty is a viable surgical alternative to total laryngectomy or tracheal diversion for controlling intractable aspiration, and preserves a phonating larynx.
Ku
P K M
PK
Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Abdullah
V J
VJ
Vlantis
A C
AC
Lee
K Y S
KY
van Hasselt
A C
AC
Tong
M C F
MC
D002908:Chronic Disease; D003679:Deglutition / Q000502:physiology; D006801:Humans; D007818:Laryngeal Diseases / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D007830:Larynx / Q000601:surgery*; D053120:Respiratory Aspiration / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D016896:Treatment Outcome; D014833:Voice Quality