Laryngotracheal separation in neonatal brainstem dysfunction.
BACKGROUND
Neonatal brainstem dysfunction (NBD) associates four symptoms of variable presence and intensity: suction-swallowing dysfunction, abnormal laryngeal sensitivity and motility, gastroesophageal reflux, and cardiac vagal overactivity.


METHODS
We report three cases of severe NBD with chronic aspiration which required surgical management. Successive failures and clinical deterioration led us to perform laryngotracheal separation. The surgical procedure consisted in suturing the distal segment of the trachea to the cervical skin after complete closure of the larynx.


RESULTS
After surgery, these children did not present any pulmonary infection and were allowed oral nutrition. However, oral communication was no longer possible. Although it is a theoretically reversible procedure, the decision is ethically difficult in children free of mental deficiency, because of the vocal loss and the unpredictable NBD outcome.


CONCLUSIONS
Laryngotracheal separation may be recommended after multidisciplinary decision for severe chronic aspiration in the particular case of children presenting with NBD.
Patron
G Cariou
GC
ENT and Head and Neck Surgery Department, Robert Debré Hospital, Paris-VII University, Paris, France. gwcariou@yahoo.fr
Teissier
N
N
Malard
O
O
Van Den Abbeele
T
T
D000015:Abnormalities, Multiple / Q000503:physiopathology; D001927:Brain Diseases / Q000151:congenital* / Q000503:physiopathology; D001933:Brain Stem / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D007830:Larynx / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D009155:Mutism / Q000503:physiopathology / Q000534:rehabilitation; D010348:Patient Care Team; D011015:Pneumonia, Aspiration / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology / Q000534:rehabilitation; D012813:Sign Language; D013575:Syncope / Q000151:congenital / Q000503:physiopathology; D014132:Trachea / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery