Surgical Approach: The Indication and Efficacy of Surgical Therapy for Aspiration Pneumonia

Abstract

The incidence of dysphagia is increasing, particularly among the elderly. Patients with severe dysphagia are unable to take food orally and also face the life-threatening condition of aspiration pneumonia. Therefore, treatment for a swallowing disorder is focused on restoring oral intake and preventing aspiration pneumonia. In cases of very severe dysphagia and in patients with progressive disease, surgical intervention is an alternative option to restore oral feeding and prevent recurrent aspiration pneumonia. Surgeries to restore swallowing function aim to address impaired pharyngolaryngeal function during the pharyngeal swallowing stage. These surgeries are indicated for patients with severely impaired pharyngeal swallowing. The oral and esophageal swallowing functions should also be maintained. The procedures used to this end include laryngeal suspension, cricopharyngeal myotomy, and vocal cord medialization. In contrast, aspiration-prevention surgery is designed to preclude the possibility of aspiration pneumonia completely, by separating the lower respiratory tract from the pharynx and larynx in cases of intractable dysphagia. Although this operation sacrifices laryngeal function, it has recently attracted attention as a method to avoid infection of the lower respiratory tract due to aspiration. Procedures including total laryngectomy, laryngotracheal separation, and laryngeal closure not only prevent aspiration pneumonia but also improve patient quality of life.