EPIGLOTTIC PLICATION FOR INTRACTABLE ASPIRATION

We describe a procedure to plicate the epiglottis into a vertical tube to prevent soiling of the airway due to intractable aspiration. The p rocedure is combined with an extensive cricopharyngeal myotomy. This t echnique allows laryngeal speech, even with a tracheostomy, and in som e patients may allow the reversal of the tracheostomy. It is only suit able for a small proportion of patients with marked aspiration, as mos t will respond to conservative treatment. Nine patients underwent this operation and six gained a satisfactory result, with two patients ach ieving tracheostomy reversal. There were two late post-operative death s from infective causes which reflects the general debilitation of the se patients and the risk of exacerbating concomitant broncho-pulmonary infection.