title: Closure of the larynx for intractable aspiration in neurologically impaired patients.
abstract: We present three patients with intractable aspiration pneumonia in the setting of permanent neurologic impairment, who had received a tracheostomy and showed a juxtaposition of the innominate artery against the trachea. Neurologically impaired patients often show a juxtaposition or compression of the innominate artery against the trachea by chest deformity in the setting of severe scoliosis, which could result in a trachea-innominate artery fistula. For intractable aspiration, laryngotracheal separation is safely performed and effective in controlling aspiration, but is occasionally complicated by trachea-innominate artery fistula. As an alternative procedure, we performed a closure of the larynx in these three cases, using double flaps of the vocal folds and false vocal folds, as a treatment for intractable aspiration. After operation, the patients did well without complication or clinical evidence of recurrent aspiration.
authors.affiliation: Department of Pediatric Surgery, Graduate School of Comprehensive Human Sciences and University Hospital, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan. tatekawa3966@diary.ocn.ne.jp
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Tatekawa
authors.forename: Noriko
authors.initials: N
authors.lastname: Hosino
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hori
authors.forename: Michio
authors.initials: M
authors.lastname: Kaneko
mesh_terms: D016122:Brachiocephalic Trunk / Q000002:abnormalities; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000150:complications; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications; D007830:Larynx / Q000002:abnormalities* / Q000601:surgery*; D008297:Male; D011015:Pneumonia, Aspiration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D015325:Pyruvate Dehydrogenase Complex Deficiency Disease / Q000150:complications; D013902:Radiography, Thoracic; D012121:Respiration, Artificial / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014139:Tracheostomy; D055815:Young Adult
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