Laryngotracheal Separation
The purpose of this procedure is to completely separate the larynx from the trachea for the treatment of severe aspiration. Although other procedures, such as glottic closure, exist, laryngotracheal separation is considered a definitive solution to severe aspiration.
Indications/Contraindications
Severe protracted aspiration with significant pulmonary insult impairing quality of life and jeopardizing pulmonary function.
Patients’ reluctance is a relative contraindication since communication will be permanently changed; they will no longer have voicing that involves the vocal folds but they can have lung-powered speech if a tracheoesophageal puncture is placed.
In the Clinical Setting
Key Point
Considerations regarding communication should be incorporated in the decision-making process. Swallowing problems may improve, but voice will be lost.
Pitfall
Patients should be appropriately counseled that while this procedure is considered reversible, it is sometimes very difficult to do so.
From a Technical Perspective
Key Points
Fistula (pharyngocutaneous fistula) formation is minimized by a watertight two-layer closure of the proximal tracheal stump.
If a ring of cartilage can be removed from the proximal stump without tearing the tracheal mucosa, the cuff of mucosa can be closed tightly without tension. The cartilage can then be brought together as a second layer, if desired.
A relaxing incision is made through the anterior-most curve of the most inferior tracheal cartilage ring so that the cartilage can be brought together without tension or buckling.
Pitfall
Separation of the tracheal mucosa from the tracheal cartilaginous rings is technically challenging and prone to mucosal tears, thereby increasing the rate of pharyngocutaneous fistula. Care should be taken in this step.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
