Surgical approaches to aspiration

Eisele, David W.

doi:10.1007/bf02493482

Cited by 53 publications

(40 citation statements)

References 49 publications

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“…Laryngotracheal separation is a therapeutic technique used to treat intractable aspiration [1,[14][15][16][17] . The procedure separates the airway and digestive systems and can eliminate aspiration completely.…”

Section: Discussionmentioning

confidence: 99%

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Laryngotracheal Closure and Cricopharyngeal Myotomy for Intractable Aspiration and Dysphagia Secondary to Cerebrovascular Accident

Li²,

Liang³

et al. 2009

ORL

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Objective: To investigate the clinical value, technique, indications and contraindications of laryngotracheal closure (LTC) and cricopharyngeal myotomy (CPM) for intractable aspiration and dysphagia secondary to a cerebrovascular accident (CVA). Materials and Methods: Patients (n = 45) with intractable aspiration and dysphagia secondary to a CVA were treated with LTC and CPM. The LTC was performed by suturing the double cords, and packing the strap muscle flap into the subglottic tracheal cavity. Results: Intractable aspiration was completely eradicated in all patients. The swallowing function was partially improved, and the patients’ quality of life was greatly improved. It became easier to care for these patients after surgery. Conclusions: LTC and CPM are suitable for intractable aspiration and dysphagia secondary to a CVA.

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Section: Discussionmentioning

confidence: 99%

“…Dysphagia and aspiration are often secondary to damaged swallowing and laryngeal functions [1,2] . Cerebrovascular accident (CVA) is the leading neurological cause of pharyngeal dysphagia and intractable aspiration [3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

Laryngotracheal Closure and Cricopharyngeal Myotomy for Intractable Aspiration and Dysphagia Secondary to Cerebrovascular Accident

Li²,

Liang³

et al. 2009

ORL

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“…This procedure prevents salivary aspiration and leads to functional improvement in swallowing [4][5][6]. Although the number of cases performed has been increasing in recent years [7], the procedure has a defect in that it usually becomes impossible for patients who underwent the TED procedure to speak using the larynx, because expirations from the lungs are exhausted through the tracheotomy hole [8,9]. The alternative is esophageal speech which functions in the same manner as a belch, and which does not use the larynx.…”

Section: Introductionmentioning

confidence: 99%

Laryngeal Phonation after Tracheoesophageal Diversion

et al. 2005

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When tracheoesophageal diversion is performed, laryngeal phonation is usually impossible. We, however, experienced the case of a 65 year-old female patient, who was able to do so. Fluoroscopic and videoendoscopic examinations elucidated her mechanism of phonation. This is the first detailed report describing the mechanism of laryngeal phonation after the procedure. Our case is compared with a few other similar cases found in available literature.

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“…Unfortunately, there has been little progress in restoring coordinated laryngeal motion after system failure originating in the brainstem [1]. With stroke often resulting in aspiration, separating the airway from the foodway on a dynamic basis [2] may become an attractive alternative to irreversible surgeries [3]. The swallowing mechanism is complex and involves precise coordination among number of muscles of various sizes, gross and vectorial anatomies, and histopathological structure.…”

Section: Introductionmentioning

confidence: 99%

Artificial Control of Glottic Adduction for Aspiration by Orderly Recruitment in the Canine

et al. 1997

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Laryngeal adduction for swallowing chiefly involves contraction of the thyroarytenoid and lateral cricoarytenoid muscles to seal the glottic chink. Vocal cord elongation supplements closure through cricoarytenoid activation. Relaxation of the posterior cricoarytenoid muscle is also involved in the swallowing process. Recent interest has focused on stimulating the laryngeal nerves to protect the lower airway from conditions where normal muscular coordination may be disrupted (e.g., in aspiration following stroke). Unfortunately, electrical stimulation results in a generalized contraction of all the dependent intrinsic laryngeal muscles because the larger, more excitable axons fire before their smaller counterparts can be activated. In the physiological state, however, the smaller fibers are recruited first. The current study focuses on electronic manipulation of force in the glottic muscles involved in deglutition. We used a stimulator that could selectively activate the intrinsic laryngeal muscles based on their specific motor unit architectures. In 5 dogs, the circuit recruited the axons in the recurrent and superior laryngeal nerves from small to large. The muscles were identified according to the differential recruitment rates of their compound muscle action potentials as they appeared on the graph. The smaller axons in the thyroarytenoid recruited faster than the large ones found in the lateral cricoarytenoid muscles, with intermediate figures observed with the cricothyroid. The posterior cricoarytenoid presented with the slowest recruitment rates, as expected from this muscle's highest contingent of larger motor units. Latencies between the onsets of stimulations and muscle saturations also appeared stable. This approach to manipulating glottic force saves energy because it allows stimulating the adductory muscles with minimal interference from their abductor antagonist.

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Surgical approaches to aspiration

Cited by 53 publications

References 49 publications

Laryngotracheal Closure and Cricopharyngeal Myotomy for Intractable Aspiration and Dysphagia Secondary to Cerebrovascular Accident

Laryngotracheal Closure and Cricopharyngeal Myotomy for Intractable Aspiration and Dysphagia Secondary to Cerebrovascular Accident

Laryngeal Phonation after Tracheoesophageal Diversion

Artificial Control of Glottic Adduction for Aspiration by Orderly Recruitment in the Canine

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