title: New surgical procedure for laryngotracheal separation without a cannula or postoperative treatment.
abstract: OBJECTIVE
  Laryngotracheal separation is a surgical procedure used in the treatment of intractable aspiration. As with total laryngectomy and laryngotracheal diversion, this procedure requires postoperative pressure above the suture location to prevent leakage at the anastomosis. To date, there have been no reports regarding laryngeal separation without postoperative treatment. The purpose of this study was to evaluate a new surgical procedure for laryngotracheal separation that is performed without a cannula and requires no postoperative treatment.
  
  
  METHODS
  We performed the new surgical procedure in 7 patients. The mucosa of the cricoid cartilage was sutured to achieve tracheal closure. The closure was covered with a musculocutaneous flap of strap muscle; gauze was then tied over the skin and a 2-0 nylon suture was used to pierce the posterior part of the cricoid cartilage. In addition, a permanent tracheostoma was constructed without a tracheal cannula.
  
  
  RESULTS
  No patients required a tracheal cannula or treatment after the operation. Additionally, aspiration pneumonia was prevented without complications in all patients.
  
  
  CONCLUSIONS
  This new surgical procedure eliminates the need for a cannula and postoperative treatment. The effects of this method in terms of aspiration prevention are comparable to those of other surgical techniques.
authors.affiliation: Department of Otolaryngology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: Muneo
authors.initials: M
authors.lastname: Nakaya
authors.forename: Yuka
authors.initials: Y
authors.lastname: Onuki
authors.forename: Wataru
authors.initials: W
authors.lastname: Kida
authors.forename: Kenta
authors.initials: K
authors.lastname: Watanabe
authors.forename: Kazuya
authors.initials: K
authors.lastname: Abe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057785:Catheters; D015331:Cohort Studies; D003413:Cricoid Cartilage / Q000601:surgery; D006801:Humans; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control; D011182:Postoperative Care; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control*; D013524:Surgical Flaps; D013536:Suture Techniques; D014132:Trachea / Q000601:surgery*; D014139:Tracheostomy; D055815:Young Adult