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A guided approach to surgery for aspiration: two case reports

Published online by Cambridge University Press:  29 June 2007

Martyn Mendelsohn
Martyn Mendelsohn*
Affiliation:
Department of Otolaryngology. Mount Sinai Hospital and University of Toronto, Toronto, Canada
*
Martyn Mendelsohn, F.R.A.C.S., 68 Ourimbah Road, Mosman, NSW, 2088, Australia
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Abstract

Aspiration frequently occurs in patients with a competent glottis. Analysis using a modified barium swallow (MBS) can reveal an extraglottic mechanism of aspiration in these patients. The MBS examination guided the design of two surgical procedures in patients with severe aspiration. The surgery corrected the underlying extraglottic cause of aspiration while preserving glottic function. In one case the epiglottoplasty controlled aspiration due to spillage over the epiglottis into the airway. In the other case translaryngeal resection of the cricoid lamina combined with cricopharyngeal myotomy controlled aspiration of residue in the hypopharynx. After surgery, both patients had their gastrostomy and cuffed tracheostomy tubes removed and were discharged home on a normal oral diet. Detailed analysis of deglutition by a modified barium swallow canprovide a scientific basis to guide the surgical management of patients with severe dysphagia.

Keywords

Deglutition disordersAspirationBarium swallowmodified
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 107 , Issue 2 , February 1993 , pp. 121 - 126
Copyright
Copyright © JLO (1984) Limited 1993

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Footnotes

Presented in part at Swallowing and Laryngology: State of the Art, Atlanta, Georgia, May 2, 1992.

References

Bevan, K., Griffiths, M. V. (1989) Chronic aspiration and laryngeal competence. Journal of Laryngology and Otology, 103: 196–199.CrossRefGoogle ScholarPubMed
Biller, H. E, Lawson, W., Baek, S.-M. (1983) Total glossectomy: a technique of reconstruction eliminating laryngectomy. Archives of Otolaryngology, 109: 69–73.CrossRefGoogle ScholarPubMed
Blitzer, A., Krespi, Y. P., Oppenheimer, R. W., Levine, T. M. (1988) Surgical management of aspiration. Otolaryngology Clinics of North America, 21: 743–750.CrossRefGoogle ScholarPubMed
Bonavina, L., Khan, N. A., DeMeester, T. R. (1985) Pharyngoesophageal dysfunctions. The role of constrictor myotomy. Archives of Surgery, 120: 541–549.CrossRefGoogle Scholar
Brookes, G. B., McKelvie, P. (1983) Epiglottopexy: a new surgical procedure to prevent intractable aspiration. Annals of the Royal College of Surgeons of England, 65: 293–296.Google Scholar
Calcaterra, T. (1971) Laryngeal suspension after supraglottic laryngectomy. Archives of Otolaryngology, 74: 306–309.CrossRefGoogle Scholar
Cannon, C. R., McLean, W. C. (1982) Laryngectomy for chronic aspiration. American Journal of Otolaryngology, 3: 145–149.CrossRefGoogle ScholarPubMed
Edgerton, M. T., Duncan, M. M. (1959) Reconstruction with loss of the hyomandibular complex in excision of large cancers. Archives of Surgery, 78: 425–436.CrossRefGoogle ScholarPubMed
Eisele, D. W. (1991) Surgical approaches to aspiration. Dysphagia, 6: 71–78.CrossRefGoogle ScholarPubMed
Habal, M. B., Murray, J. E. (1972) Surgical treatment of lifeendangering chronic aspiration pneumonia. Plastic and Reconstructive Surgery, 49: 305–311.CrossRefGoogle ScholarPubMed
Hillel, A. D., Goode, R. L. (1983) Lateral laryngeal suspension: a new procedure to minimize swallowing disorders following tongue base resection. Laryngoscope, 93: 26–31.CrossRefGoogle ScholarPubMed
Kahrilas, P. J., Dent, J., Dodds, W. J. (1987) A method for continuous monitoring of upper esophageal sphincter pressure. Digestive Diseases and Sciences, 32: 121–128.CrossRefGoogle ScholarPubMed
Krespi, Y., Sisson, G. (1985) Management of chronic aspiration by subtotal and submucosal cricoid resection. Annals of Otology Rhinology and Laryngology, 94: 580–583.CrossRefGoogle ScholarPubMed
Laurian, N., Shvili, Y., Zohar, Y. (1986) Epiglotto-aryepiglottopexy: a surgical procedure for severe aspiration. Laryngoscope, 96: 78–81.CrossRefGoogle ScholarPubMed
Lazarus, C., Logemann, J. A. (1987) Swallowing disorders in closed head trauma patients. Archives of Physical Medicine and Rehabilitation, 68: 79–84.Google ScholarPubMed
Lebo, C. P., Sang, K., Norris, F. H. (1976) Cricopharyngeal myotomy in amyotrophic lateral sclerosis. Laryngoscope, 86: 862–868.CrossRefGoogle ScholarPubMed
Lindeman, R. A. (1975) Diverting the paralyzed larynx: a reversible procedure for intractable aspiration. Laryngoscope, 85: 157–180.CrossRefGoogle ScholarPubMed
Logemann, J. A. (1983) Evaluation and treatment of swallowing disorders. College Hill Press, San Diego.Google Scholar
Logemann, J. A., Bytell, D. E. (1979) Swallowing disorders in three types of head and neck surgical patients. Cancer, 44: 1095–1105.3.0.CO;2-C>CrossRefGoogle ScholarPubMed
Logemann, J. A. (1985) Aspiration in head and neck surgical patients. Annals of Otology Rhinology and Laryngology, 94: 373–376.CrossRefGoogle ScholarPubMed
McConnel, F. M. S., Cerenko, D., Mendelsohn, M. S. (1988) Manofluorographic analysis of swallowing. Otolaryngology Clinics of North America, 21: 625–635.CrossRefGoogle ScholarPubMed
Mendelsohn, M. S., McConnel, F. M. S. (1987) Function in the pharyngoesophageal segment. Laryngoscope, 97: 483–489.CrossRefGoogle ScholarPubMed
Mendelsohn, M. S. (1988) The modified barium swallow in clinical practice. Journal of the Otolaryngology Society of Australia, 6: 97–104.Google Scholar
Mills, C. P. (1973) Dysphagia in pharyngeal paralysis treated by cricopharyngeal myotomy. Lancet, 1: 455–457.CrossRefGoogle Scholar
Mitchell, R. L., Armanini, G. B. (1975) Cricopharyngeal myotomy. Treatment of dysphagia. Annals of Surgery, 181: 262–266.CrossRefGoogle ScholarPubMed
Montgomery, W. W. (1975) Surgical laryngeal closure to eliminate chronic aspiration. New England Journal of Medicine, 292: 1390–1391.CrossRefGoogle ScholarPubMed
Orlowski, J., Dodds, W. J., Linehan, J. H. (1982) Requirements for accurate manometric recording of pharyngeal and esophageal peristaltic pressure waves. Investigative Radiology, 17: 567–571.CrossRefGoogle ScholarPubMed
Sasaki, C. T., Milmoe, G., Yanagisawa, E. J. (1980) Surgical closure of the larynx for intractable aspiration. Archives of Otolaryngology, 106: 422–423.CrossRefGoogle ScholarPubMed
Strome, M., Fried, M. P. (1983) Rehabilitative surgery for aspiration. Archives of Otolaryngology, 109: 809–811.CrossRefGoogle ScholarPubMed
Veis, S. L., Logemann, J. A. (1984) Swallowing disorders in persons with cerebrovascular accident. Archives of Physical Medicine and Rehabilitation, 66: 372–375.Google Scholar
Youngs, R., Chalstrey, S. (1989) Otolaryngological management of the patient with chronic aspiration. College Speech Therapy Bulletin, 446: 2–3.Google Scholar