Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration

Abstract

A novel narrow-field laryngectomy procedure known as central-part laryngectomy (CPL) for less invasive laryngeal diversion in patients with intractable aspiration is introduced. We conducted retrospective case reviews of 15 patients who underwent CPL. In this procedure, an area of the glottis including the mid-part of the thyroid cartilage and cricoid cartilage is removed to separate the digestive tract from the air way. The lateral part of the thyroid cartilage, the entire hypopharyngeal mucosa and epiglottis are preserved. The superior laryngeal vessels and nerve are not invaded. All fifteen patients were relieved of aspiration without major complications. In good accordance with cutting of the cricopharyngeal muscles and removal of the cricoid cartilage, postoperative videofluoroscopy demonstrated smooth passages of barium. Ten of 12 patients who had hoped to resume oral food intake became able to do so after CPL and two others also achieved partial oral deglutition. CPL is a useful procedure for treatment of intractable aspiration and offers considerable advantages over other laryngotracheal diversion procedures from the view point of oral food intake.

Choice of Aspiration Prevention Surgery for Patients With Neuromuscular Disorders: Report of Three Cases

“…Total laryngectomy is highly invasive because of general anesthesia, longer operation time, and larger amount of bleeding compared with other techniques (13, 14). Central-part laryngectomy is less invasive compared to total laryngectomy because operation time is shorter and bleeding is limited (9). Laryngotracheal separation and diversion are also less invasive because these techniques can be performed under both general and local anesthesia and bleeding is limited and operation time is shorter than those in total laryngectomy (10, 11).…”

“…Reduction of the abnormally high pressure at the UES was considered important for smooth pharyngoesophageal passage in this patient. As cricopharyngeal myotomy appeared to insufficiently contribute to the improvement of UES opening during swallowing due to physical obstruction by the remaining lamina of the cricoid cartilage, modified central-part laryngectomy (9), which is less invasive and reduces the pressure of the UES by removing the whole cricoid cartilage, was performed (Figures 1C,D). Intraoperative bleeding was limited, and the operation lasted 151 min.…”

“…It has been reported that aspiration prevention surgery for severe dysphagia can improve the quality of life of patients and their families and help patients regain oral intake (6–8). There are several surgical techniques for aspiration prevention, such as total laryngectomy, central-part laryngectomy, tracheoesophageal diversion, laryngotracheal separation, and laryngeal closure (7, 9–12). Total laryngectomy is performed under general anesthesia and is highly invasive with longer operation time and larger amount of bleeding compared with other procedures (13, 14).…”

“…Total laryngectomy is performed under general anesthesia and is highly invasive with longer operation time and larger amount of bleeding compared with other procedures (13, 14). Central-part laryngectomy is conducted under general anesthesia and it is less invasive compared to total laryngectomy (9). Laryngotracheal separation and diversion have been performed since the 1970s, and these techniques can take place under both general and local anesthesia (10, 11).…”

A laryngeal closure technique for the treatment of patients with head and neck cancer

“…In Japan, the number of elderlies has been increasing at an astonishing rate, and patients with dysphagia also continue to increase. To address this issue, several new safe and less invasive surgeries, such as centralpart laryngectomy, 11 tracheal flap method, 12 and laryngeal closure, 6 have been developed to prevent aspiration. Among them, laryngeal closure (Kano's method) has been most widely performed, since Kano's methods have several advantages, such as lower rate of leakage, large tracheostoma, operability for patients with lower larynx and/or obesity, and feasibility of simultaneous cricopharyngeal myotomy.…”