Separation of the larynx and trachea for intractable aspiration

Abstract

Aspiration becomes an intractable problem for some patients who have lost normal neurological function of the glottis. Over the long term, a cuffed tracheotomy tube is inadequate. Several methods have been developed to relieve this problem surgically. These include the use of muscle flaps, tracheoesophageal anastomosis, and use of an epiglottic flap. In this paper, we discuss these previous surgical attempts to alleviate aspiration and present our own technique, which involves creation of a tracheostome and closure of the larynx at the level of the first tracheal ring. This has been used with success in three patients. We feel this technique is less complex and results in less surgical trauma to the larynx, important factors when dealing with critically ill patients. This_ technique is theoretically reversible by re-anastomosing the trachea to the cricoid cartilage after excising the first tracheal ring.