重度誤えんに対する喉頭閉鎖手術 後部声門の閉鎖を併用した改良術式

Abstract

The posterior part of the larynx closes completely not at the glottis but at the supraglottis, and the bilateral arytenoids come into contact at the superior portion of the arytenoid cartilage from the vocal process to the apex. We have performed surgical closure of the larynx for intractable aspiration using this functional anatomy of the posterior glottis.Our operative procedure was as follows. 1) Suprahyoid pharyngotomy was performed under general anesthesia. 2) To close the posterior part of the larynx, the mucosa of the superior portion of the arytenoids was removed to make a raw surface, and bilateral arytenoid cartilages were sutured. Then, the mucosa of the bilateral arytenoids was also sutured. 3) To close the supraglottis, the mucosa of both the aryepiglottic folds and the laryngeal surface of the epiglottis were removed and sutured to each other.The advantages of this procedure were the following. 1) This method makes a complete closure of the posterior part of the larynx. As a result, it prevents aspiration securely. 2) This method can make a closure of not only the supraglottis but also of the glottis using the suprahyoidpharyngeal approach.