Reversal of laryngotracheal separation in paediatric patients.

Hdl Handle:
http://hdl.handle.net/10147/207431
Title:
Reversal of laryngotracheal separation in paediatric patients.
Authors:
Young, Orla; Cunningham, Catherine; Russell, John D
Affiliation:
Department of Paediatric Otolaryngology, Our Lady's Hospital for Sick Children,, Drimnagh Road, Crumlin, Dublin 12, Ireland. orlayoung@gmail.com
Citation:
Int J Pediatr Otorhinolaryngol. 2010 Nov;74(11):1251-3.
Journal:
International journal of pediatric otorhinolaryngology
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207431
DOI:
10.1016/j.ijporl.2010.07.024
PubMed ID:
20817277
Abstract:
OBJECTIVE: Laryngotracheal separation (LTS) is an effective and reliable definitive treatment for intractable aspiration. A major advantage of this treatment for intractable aspiration is its' potential reversibility. Should the underlying disorder improve, a reversal of the procedure may be attempted. This has been successfully achieved in the adult population. To our knowledge, no previous cases have been reported of successful reversal of LTS in children. METHODS: A retrospective review from 2003 to 2010 identified four cases of intractable aspiration treated with LTS in our department. Two of these patients displayed objective evidence of sufficient recovery of their underlying aspiration to consider reversal. Patient selection for reversal was dependent upon successful oral intake for 9 months along with videofluoroscopic evidence of normal or minimally impaired swallow. RESULTS: Two children who were successfully treated for intractable aspiration with LTS demonstrated objective evidence of recovery sufficient to attempt reversal. Both children underwent successful surgical reversal of LTS using a cricotracheal resection with end-to-end anastamosis, similar to that used in treatment of subglottic stenosis. Both children can now tolerate oral diet and their speech and language development is in line with their overall developmental level. CONCLUSIONS: Laryngotracheal separation is an effective and reliable definitive treatment for intractable aspiration facilitating protection of the airway and allowing safe swallowing with unimpeded respiration, but with the major drawback of loss of phonation. To our knowledge, we document the first two cases of successful LTS reversal in children.
Language:
eng
MeSH:
Anastomosis, Surgical; Child, Preschool; Cranial Nerve Diseases/complications; Cricoid Cartilage/surgery; Deglutition Disorders/etiology/surgery; Humans; Infant; Larynx/*surgery; Male; *Otorhinolaryngologic Surgical Procedures; Paresis/complications; Pneumonia, Aspiration/etiology/prevention & control; Respiratory Aspiration/etiology/surgery; Retrospective Studies; Speech Intelligibility; Trachea/*surgery
ISSN:
1872-8464 (Electronic); 0165-5876 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorYoung, Orlaen_GB
dc.contributor.authorCunningham, Catherineen_GB
dc.contributor.authorRussell, John Den_GB
dc.date.accessioned2012-02-01T10:24:50Z-
dc.date.available2012-02-01T10:24:50Z-
dc.date.issued2012-02-01T10:24:50Z-
dc.identifier.citationInt J Pediatr Otorhinolaryngol. 2010 Nov;74(11):1251-3.en_GB
dc.identifier.issn1872-8464 (Electronic)en_GB
dc.identifier.issn0165-5876 (Linking)en_GB
dc.identifier.pmid20817277en_GB
dc.identifier.doi10.1016/j.ijporl.2010.07.024en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207431-
dc.description.abstractOBJECTIVE: Laryngotracheal separation (LTS) is an effective and reliable definitive treatment for intractable aspiration. A major advantage of this treatment for intractable aspiration is its' potential reversibility. Should the underlying disorder improve, a reversal of the procedure may be attempted. This has been successfully achieved in the adult population. To our knowledge, no previous cases have been reported of successful reversal of LTS in children. METHODS: A retrospective review from 2003 to 2010 identified four cases of intractable aspiration treated with LTS in our department. Two of these patients displayed objective evidence of sufficient recovery of their underlying aspiration to consider reversal. Patient selection for reversal was dependent upon successful oral intake for 9 months along with videofluoroscopic evidence of normal or minimally impaired swallow. RESULTS: Two children who were successfully treated for intractable aspiration with LTS demonstrated objective evidence of recovery sufficient to attempt reversal. Both children underwent successful surgical reversal of LTS using a cricotracheal resection with end-to-end anastamosis, similar to that used in treatment of subglottic stenosis. Both children can now tolerate oral diet and their speech and language development is in line with their overall developmental level. CONCLUSIONS: Laryngotracheal separation is an effective and reliable definitive treatment for intractable aspiration facilitating protection of the airway and allowing safe swallowing with unimpeded respiration, but with the major drawback of loss of phonation. To our knowledge, we document the first two cases of successful LTS reversal in children.en_GB
dc.language.isoengen_GB
dc.subject.meshAnastomosis, Surgicalen_GB
dc.subject.meshChild, Preschoolen_GB
dc.subject.meshCranial Nerve Diseases/complicationsen_GB
dc.subject.meshCricoid Cartilage/surgeryen_GB
dc.subject.meshDeglutition Disorders/etiology/surgeryen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInfanten_GB
dc.subject.meshLarynx/*surgeryen_GB
dc.subject.meshMaleen_GB
dc.subject.mesh*Otorhinolaryngologic Surgical Proceduresen_GB
dc.subject.meshParesis/complicationsen_GB
dc.subject.meshPneumonia, Aspiration/etiology/prevention & controlen_GB
dc.subject.meshRespiratory Aspiration/etiology/surgeryen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshSpeech Intelligibilityen_GB
dc.subject.meshTrachea/*surgeryen_GB
dc.titleReversal of laryngotracheal separation in paediatric patients.en_GB
dc.contributor.departmentDepartment of Paediatric Otolaryngology, Our Lady's Hospital for Sick Children,, Drimnagh Road, Crumlin, Dublin 12, Ireland. orlayoung@gmail.comen_GB
dc.identifier.journalInternational journal of pediatric otorhinolaryngologyen_GB
dc.description.provinceLeinster-
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