Surgery for Aspiration: Analysis of Laryngotracheal Separation in 23 Children

Abstract

The aim of this study was to analyze the efficacy of laryngotracheal separation (LTS) in eliminating aspiration in children by comparing pre- and postoperative conditions. This prospective study used an internal control group. Children with neurologic impairment and a diagnosis of chronic aspiration were subjected to LTS at the Associação de Assistência à Criança Deficiente (AACD). Twenty-three children had undergone LTS with the modified Lindeman technique. All of them gained complete control of aspiration. Frequency of hospitalization, number of respiratory infections, and level of secretion were statistically reduced. After surgery only 21.7% of the children were capable of oral intake exclusively. LTS is an effective and safe technique that can be used in children resulting in aspiration control in 100% of the patients and without repercussions in the respiratory secretion and pulmonary infections.

Dysphagia and aspiration in children

“…There is a loss of phonation, and the patient is left with a permanent tracheostomy 79. Two recent studies from Japan and one from Brazil documented the effectiveness of this procedure in children with intractable aspiration, particularly those who are neurologically impaired 189–191. However, complications can be considerable, such as tracheal granulations, bleeding, stenosis of the tracheal stoma, tracheomalacia, tracheal abscess, ruptured sutures, and tracheocutaneous fistula 189.…”

Deglutition and Respiration: Development, Coordination, and Practical Implications

“…Laryngotracheal separations have been successful in eliminating aspiration in a select group of children with profound neurodevelopmental delays and intractable aspiration pneumonia. [109][110][111] Decision making about what and how much to feed children with aspiration is subjective because there are no established guidelines to define aspiration tolerance. Investigations are needed to identify the best clinical practices for obtaining optimal respiratory outcomes in children with dysphagia and respiratory disease.…”

Safety and caregiver satisfaction with gastrostomy in patients with Ataxia Telangiectasia

“…Increased morbidity and mortality is associated with impairments in deglutition, nutritional status, immune function, and neurologic status in other chronic progressive conditions [11-14]. Treatments that improve nutritional status and minimize the risk of aspiration for patients with chronic progressive disorders are salutary[15-20]. Thus it is important to provide information that guides clinicians in the selection of interventions for nutrition and aspiration induced lung injury with progressive conditions.…”