A simple method to alleviate aspiration in the near-total laryngectomy patient

Abstract

Near-total laryngectomy is a surgical technique which grants the potential for postoperative speech without the need for prostheses or secondary surgical procedures. Aspiration can be a problem, however, that can require completion laryngectomy to resolve. A 60-year-old male underwent a near-total laryngectomy for recurrent laryngeal cancer. The patient developed chronic aspiration secondary to a leaking shunt. Work up was negative for recurrent cancer. Calcium hydroxylapatite was injected transorally at the opening into the shunt and transtomally into the exit of the shunt to seal it. Postoperative barium swallow showed resolution of aspiration. At approximately 17 months, the patient developed recurrent intermittent aspiration of thin liquids and required reinjection of the shunt, with resolution of the aspiration. Calcium hydroxylapatite allows simple and effective alleviation of aspiration following near-total laryngectomy but requires repeated injection to maintain efficacy. Injection of calcium hydroxylapatite can be an effective alternative to completion laryngectomy in patients who aspirate following near-total laryngectomy.