Surgical Interventions as a Treatment Option for Severe Dysphagia with Intractable Aspiration: Concept, Indications, and Efficacy

Abstract

The incidence of dysphagia is increasing, particularly among the elderly according to varied of causes. Patients with severe dysphagia are unable to take food orally and are at risk for life-threatening aspiration pneumonia. Treatments for swallowing disorders focus on restoring oral food intake and preventing recurrent aspiration pneumonia. Therefore, swallowing rehabilitation and food texture modifications are essential. However, in cases with severe or progressive dysphagia, these conservative treatments may not restore oral feeding and prevent intractable aspiration pneumonia. In these cases, surgical interventions has recently been attracted as an alternative treatment option. In this article, we present its concept, indications, and efficacy. Surgeries to restore swallowing function address impaired pharyngolaryngeal motor function during the pharyngeal swallowing stage while preserving laryngeal functions. These procedures include laryngeal elevation, cricopharyngeal myotomy, and vocal cord medialization. Meanwhile, aspiration prevention surgeries reduce the risk of aspiration pneumonia by separating the lower respiratory tract from the pharynx and larynx. These procedures include total laryngectomy, laryngotracheal separation, and glottal closure; although they do not spare laryngeal functions, they prevent aspiration pneumonia completely, improve quality of life, and reduce the burden on caregivers. Clinicians should be aware of surgical interventions as a possible treatment option for intractable dysphagia. Establishment and popularization of the surgical indications are the future issues.