Hostname: page-component-669899f699-swprf Total loading time: 0 Render date: 2025-05-03T15:29:13.010Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of intractable aspiration – combined open medialisation thyroplasty with intra-glandular botulinum toxin injection

Published online by Cambridge University Press:  11 November 2024

Sakina Ghauth Open the ORCID record for Sakina Ghauth [Opens in a new window]  and
Sien Hui Tan Open the ORCID record for Sien Hui Tan [Opens in a new window]
Sakina Ghauth*
Affiliation:
Department of Otolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia
Sien Hui Tan
Affiliation:
Department of Otolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia
*
Corresponding author: Sien Hui Tan; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This paper aims to introduce our combined approach, which provides definitive treatment for intractable aspiration while preserving phonation and highlights the importance of performing both procedures together.

Methods

We describe a case of intractable aspiration requiring a nasogastric tube and a tracheostomy tube. We propose a combined technique consisting of an open medialisation thyroplasty with intra-operative, intra-glandular botulinum toxin injection. The thyroplasty procedure medialises the left vocal fold to overcome glottic insufficiency. Botulinum toxin injection reduces salivary flow and prevents excessive pooling.

Results

The patient was followed up for twelve months. Video fluoroscopy demonstrated no evidence of aspiration. The patient was allowed a regular oral diet and decannulated two months post-operatively.

Conclusion

This paper demonstrates the feasibility of our combined approach as a viable treatment option for intractable aspiration, particularly in patients with a strong desire for vocalisation. The cases must be selected carefully to ensure a favourable outcome.

Keywords

aspiration pneumoniathyroplastybotulinum toxinvocal cord palsy
Type
Short Communications
Information
The Journal of Laryngology & Otology , First View , pp. 1 - 3
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Bartlett, JG, Gorbach, SL. The triple threat of aspiration pneumonia. Chest 1975;68:560–6Google Scholar
Cannon, CR, McLean, WC. Laryngectomy for chronic aspiration. Am J Otolaryngol 1982;3:145-9Google Scholar
Tomita, T, Tanaka, K, Shinden, S, Ogawa, K. Tracheoesophageal diversion versus total laryngectomy for intractable aspiration. J Laryngol Otol 2004;118:15–8Google Scholar
Kawamoto, A, Katori, Y, Honkura, Y, Kakuta, R, Higashi, K, Ogura, M, et al. Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration. Eur Arch Otorhinolaryngol 2014;271:1149–55Google Scholar
Lindeman, RC. Diverting the paralyzed larynx: A reversible procedure for intractable aspiration. Laryngoscope 1975;85:157–80Google Scholar
Eisele, DW, CT, Yarington Jr, Lindeman, RC, WF, Larrabee Jr. The tracheoesophageal diversion and laryngotracheal separation procedures for treatment of intractable aspiration. Am J Surg 1989;157:230–6Google Scholar
Snyderman, CH, Johnson, JT. Laryngotracheal separation for intractable aspiration. Annotol Rhinol Laryngol 1988;97:466–70Google Scholar
Eibling, DE, Snyderman, CH, Eibling, C. Laryngotracheal separation for intractable aspiration: A retrospective review of 34 patients. Laryngoscope 1995;105:83–5Google Scholar
Remacle, M, Marza, L, Lawson, G. A new epiglottoplasty procedure for the treatment of intractable aspiration. Eur Arch Otorhinolaryngol 1998;255:64–7Google Scholar
Sato, K, Nakashima, T. Surgical closure of the larynx for intractable aspiration: Surgical technique using closure of the posterior glottis. Laryngoscope 2003;113:177–9Google Scholar
Atallah, I, Castellanos, PF. Transoral closure of the supraglottic larynx for intractable aspiration. Head Neck 2021;43:1370–5Google Scholar
Takano, S, Goto, T, Kabeya, M, Tayama, N. Surgical closure of the larynx for the treatment of intractable aspiration: surgical technique and clinical results. Laryngoscope 2012;122:1273–8Google Scholar