Tracheoesophageal Diversion to Prevent Chronic Respiratory and Swallowing Disorders in Severely Handicapped Men

• Published in: Rihabiritēshon igaku Vol. 30; no. 9; pp. 647 - 656
• Main Authors: FUNAHASHI, Masuko, CHO, Hiroyuki, SUZUKI, Yasuyuki, KUDO, Hideaki, MATSUO, Takiko, KONOMI, Hiroshi, HORIGUCHI, Satoshi, HAYASHIDA, Tetsuro, TAMAGAWA, Kimiko
• Format: Journal Article
• Language: English
• Published: The Japanese Association of Rehabilitation Medicine 1993
• Subjects: aspiration pneumonia; missdeglutition; respiratory failure; tracheoesophageal diversion; tracheostomy
• ISSN: 0034-351X; 1880-778X
• DOI: 10.2490/jjrm1963.30.647

It is very common to see severely handicapped men having chronic respiratory failure due to recurrent aspiration pneumonia. To prevent missdeglutition, separation procedures of an airway from foods passage were employed. The results and the effectiveness, in terms of prevention of aspiration and complications, of various types of surgical procedures (simple tracheostomy, vocal cord plication procedures, total laryngectomy, tracheoesophageal diversion) were compared. Simple tracheostomy was performed on 15 patients. This procedure is very common and easy to perform, however, many complications such as tracheal erosion and granulation were not negligible. And the results of the procedure were not satisfactory for preventing aspiration. Additional surgical procedure such as vocal cord plication was needed for 4 patients. Vocal cord plication procedure (Montgomery WW, 1975) was performed on 4 patients. Although a pin-hole on the plicated glottis was seen after the operation in 3 patients, aspiration was satisfactorily minimized. On 2 patients, total laryngectomy was chosen. This procedure provides complete protection of airway, however, total removal of larynx pressed heavy mental stress upon patients and their families, because of the lack of possibility of functional reconstruction in the future. Therefore, this procedure should be avoided. Tracheoesophageal diversion (Lindeman RC, 1975), which keeps larynx aside from airway, was tried on 4 patients. This procedure was slightly complicated yet, it was the most applicable with respect to realization of oral feeding, prevention of aspiration pneumonia, improvement of respiratory function and nutrition. The tracheoesophageal diversion completely freed patients from aspiration with minimal complication. In addition to that, the procedure keeps patients and their families having hope for functional reconstruction of larynx in the future, although the possibility of the restoration depends upon the patient's neurological condition. After this operation, patients become animated and active in the life.