title: [Evaluation of surgical treatment for intractable aspiration in neurologically impaired patients: our experience with 20 patients].
abstract: OBJECTIVE
  The present study aimed to evaluate the efficacy of surgical treatment for intractable aspiration in patients with severe motor and intellectual disabilities (SMID) and neuromuscular diseases (NMD).
  
  
  METHODS
  A retrospective analysis was performed of 20 patients who underwent laryngotracheal separation (LTS) or the tracheal flap method (TFM) between 2003 and 2012 at Gunma Children's Medical Center.
  
  
  RESULTS
  All patients were bedridden and fed either through a naso-gastric or naso-esophageal tube or via a gastric fistula. Of the 20 participants, 60% underwent surgical treatment before 3 years of age. The incidence of aspiration pneumonia decreased after surgery, and 8 of 10 patients, who were previously hospitalized for a long duration, were discharged. The most frequent complications observed were granulation around the tracheostomy stoma and endotracheal granuloma. Two patients presented with a tracheal fistula.
  
  
  CONCLUSIONS
  LTS and TFM can be used as treatment modalities for patients with intractable aspiration along with SMID and NMD. In patients with intractable aspiration, after considering their underlying conditions, adaptation and type of operative procedures should be determined.
authors.forename: Mio
authors.initials: M
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Shiihara
mesh_terms: D000293:Adolescent; D001240:Aspirations, Psychological; D001927:Brain Diseases; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D014132:Trachea / Q000601:surgery*; D014139:Tracheostomy; D055815:Young Adult