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Reversal of laryngotracheal separation in paediatric patients.
Young, Orla Cunningham, Catherine Russell, John D
Young, Orla
Cunningham, Catherine
Russell, John D
Advisors
Editors
Other Contributors
Departments
Department of Paediatric Otolaryngology, Our Lady's Hospital for Sick Children,, Drimnagh Road, Crumlin, Dublin 12, Ireland. orlayoung@gmail.com
Date
2012-02-01T10:24:50Z
Date Submitted
Keywords
Other Subjects
Subject 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
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
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
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
ISSN
1872-8464 (Electronic)
0165-5876 (Linking)
0165-5876 (Linking)
eISSN
ISBN
DOI
10.1016/j.ijporl.2010.07.024
PMID
20817277