Laryngectomy for aspiration: Narrow field technique

Abstract

Patients with intractable aspiration present formidable management difficulties. Many surgical solutions have been devised. In cases in which there is life-threatening aspiration and no prospect of reversal of the underlying pathology, we use narrow-field laryngectomy to prevent aspiration-associated pleuropulmonary infections. The surgical technique comprises sparing of strap muscles, a high tracheal transection, and conserving a maximum amount of pharyngeal mucosa, so that the pharyngeal opening is quite small and may be closed rapidly. We have used this approach successfully in 10 patients. Narrow-field laryngectomy has proven to be a safe, efficacious technique for the management of persistent aspiration in these gravely ill patients.