Subglottic laryngeal closure: a unique modified method of laryngotracheal separation to prevent aspiration.
OBJECTIVE
Laryngotracheal separation (LTS) is an ideal surgical method for intractable aspiration; however, the oral side of the tracheal stump can easily disintegrate. Therefore, we developed a modified LTS method. We performed subglottic laryngeal closure (SGLC) as a new surgical method and evaluated the outcomes.


METHODS
We retrospectively analyzed the medical records of 36 patients (28 male and 8 female; 15 to 91 years of age) who underwent SGLC between 2007 and 2011 at Tottori University Hospital, Japan. Operative data (operative time, intraoperative bleeding, and time to drain removal), outcomes (aspiration and changes in nutritional status), and complications with regard to the surgical method were examined. The occurrence of a subcutaneous proximal laryngeal stump fistula was evaluated by videofluoroscopy.


RESULTS
The SGLC was performed safely in all patients. Fistulization was observed in only 1 of the patients (2.8%), and major bleeding after surgery was observed in 1 patient (2.8%). The procedure relieved aspiration pneumonia in all patients.


CONCLUSIONS
We conclude that SGLC is effective for treating and preventing pulmonary aspiration. The incidence of postoperative complications, particularly that of subcutaneous fistulas, was very low. Therefore, this method may be useful for patients in poor condition.
Department of Sensory and Motor Organs, Division of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
Naritomo
N
Miyake
Katsuyuki
K
Kawamoto
Kazunori
K
Fujiwara
Yuji
Y
Hasegawa
Hiroya
H
Kitano
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005931:Glottis; D006801:Humans; D058753:Laryngoplasty / Q000379:methods*; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014139:Tracheostomy; D014140:Tracheotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome