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.