PATIENT SELECTION FOR PRIMARY LARYNGOTRACHEAL SEPARATION AS TREATMENTOF CHRONIC ASPIRATION IN THE IMPAIRED CHILD

Chronic aspiration in the neurologically impaired child is associated with significant medical and social complications. Traditional surgica l management has often relied on tracheotomy. This may well fail to co ntrol aspiration. The purpose of this retrospective study was to deter mine which neurologically impaired children would benefit from a laryn gotracheal separation (LTS), as opposed to tracheotomy, as the primary surgical procedure to control chronic salivary aspiration. Patient se lection was based on neurologic status, verbal communication ability, likelihood of neurologic recovery, and failure of previous treatments to control aspiration. Nineteen neurologically impaired children aged 8-172 months with chronic salivary aspiration underwent LTS. A total o f 73.6% of these patients had prior tracheotomies, yet they continued to aspirate. Two early and three late complications were noted. No ins tances of fistula formation were noted. There were no deaths related t o complications of the surgery or persistent aspiration. Follow-up 1-6 2 months after surgery demonstrated that complete control of the aspir ation was achieved in all of these children. Two of the children who h ad achieved verbal communication prior to the procedure lost this abil ity. Improved general hearth and ability to resume oral intake was not ed in all patients. This, combined with a decrease in the need of freq uent suctioning, was felt by the families of these children to be a ma jor improvement in the quality of life. Laryngotracheal separation app ears to be a simple and effective means of controlling chronic aspirat ion. It should be considered as a primary treatment of aspiration in t he properly selected child with neurologic disease.