A Novel Approach for the Treatment of Intractable Aspiration After Supracricoid Laryngectomy

• Published in: Annals of otology, rhinology & laryngology p. 34894231176892
• Main Authors: Alsavaf, Mohammad Bilal, Tardif, Jacqueline, Salem, Eman H, Matrka, Laura, Carrau, Ricardo L
• Format: Journal Article
• Language: English
• Published: United States 01.12.2023
• Subjects: endoscopic; supracricoid laryngectomy; laser; dysphasia; limited epiglottic movement; aspiration
• ISSN: 1943-572X
• DOI: 10.1177/00034894231176892

This manuscript aims to present a novel and successful intervention for intractable aspiration following a supracricoid laryngectomy (SCL) that may avoid the need for total laryngectomy in patients experiencing intractable aspiration after SCL. This report describes a novel approach to treat intractable aspiration and feeding tube-dependency due to an incomplete posterior apposition of the laryngeal surface of the epiglottis to the arytenoids after a SCL in a 67-year-old man. The right and left aryepiglottic folds and the median glossoepiglottic fold were denuded using a CO laser. Then, an arytenoepiglottopexy was completed by placing 4-0 Vicryl between the lateral aspect of the epiglottis and arytenoids; thus, approximating these structures. Two weeks after surgery, fiberoptic endoscopic evaluation of swallowing demonstrated improved closure of the larynx upon swallowing with great upgrading in the Penetration-Aspiration scale (PAS). PAS improved from a 6 to 2, corresponding to, transient penetration for moderately thick liquids and puree solids. He also demonstrated improved secretion management and airway protection. Following a 4-week course of intensive dysphagia therapy, a modified barium swallow revealed a significant improvement in airway protection, with a PAS score of 1 (no airway invasion). Chronic aspiration is a life-threatening condition that can severely reduce patients' quality of life. Despite the use of current therapeutic approaches, a subset of patients will remain plagued by persistent symptoms. We introduce an innovative, simple, and quick endoscopic technique that offers benefit in controlling aspiration after SCL. NA.