Secondary Voice Restoration After Laryngotracheal Separation (LTS) for Dysphagia with Intractable Aspiration.
Intractable aspiration is a serious, often life-threatening condition due to its potential impact on pulmonary function. Aspiration requires therapeutic measures, starting with conservative management but often necessitating surgical treatment. The basic surgical principle is to separate the alimentary and respiratory tracts through a variety of procedures which, unfortunately, nearly all result in the loss of phonation, with the exception of total laryngectomy (TL) which includes the placement of an indwelling voice prosthesis. In this study, we present a modified laryngotracheal separation (LTS) technique that, we believe, offers multiple advantages compared to standard TL. After reviewing the medical records of 35 patients with intractable aspiration who have undergone LTS, we describe the surgical technique and present the postoperative result. In a second surgical procedure about two months following LTS, we aimed to achieve voice restoration by placement of an indwelling voice prosthesis. Intractable aspiration was successfully treated in all patients. Placement of an indwelling voice prosthesis during a second operation was successful in 15 patients, representing the largest reported cohort thus far. LTS is a reliable surgical technique to treat intractable aspiration, with restoration of oral intake, thereby improving the general condition and quality of life of these unfortunate patients. Furthermore, voice restoration can be achieved in selected patients, by placement of a voice prosthesis.
Department of Head, Neck & Maxillofacial Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Katrien
K
Bonte
Department of Head, Neck & Maxillofacial Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. Wouter.Huvenne@uzgent.be.
Wouter
W
Huvenne
Department of Head, Neck & Maxillofacial Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Marie
M
De Loof
Department of Head, Neck & Maxillofacial Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Philippe
P
Deron
Department of Physical Therapy and Motor Rehabilitation, Ghent University Hospital, Ghent, Belgium.
Annick
A
Viaene
Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
Fréderic
F
Duprez
Department of Head, Neck & Maxillofacial Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Hubert
H
Vermeersch
D000368:Aged; D003680:Deglutition Disorders / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010699:Phonation / Q000502:physiology*; D011015:Pneumonia, Aspiration / Q000209:etiology* / Q000517:prevention & control; D011184:Postoperative Period; D020127:Recovery of Function; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*; D014132:Trachea / Q000601:surgery*; D014832:Voice Disorders / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014833:Voice Quality / Q000502:physiology
Deglutition; Deglutition disorders; Intractable aspiration; Laryngotracheal separation; Surgical management