Laryngeal framework surgery for the management of aspiration

Background. During the past decade, laryngeal framework surgery has become the treatment of choice for the management of adductor paralysis of the voc al fold. The primary impetus for the use of this technique has been on the rehabilitation of voice. The purpose of this study was to ascertain the eff ectiveness of laryngeal framework surgery, including medialization laryngop lasty with silicone (MLS), with or without arytenoid adduction (AA), on eli minating aspiration, improving diet, and aiding in the subsequent decannula tion of individuals with glottic insufficiency secondary to vocal fold pals y. Methods. A retrospective chart review was performed on all patients initial ly seen with vocal cord paralysis who were treated with laryngeal framework surgery from June 1992 to April 1996. The study comprised 70 patients, inc luding 31 women and 39 men, with a median age of 57 years. Clinical informa tion was obtained regarding the etiology of the lesion, characteristics of the vocal cord deficit, history of aspiration, the presence of other neurol ogic deficits or concurrent pulmonary disease, treatment, and outcome. To d etermine the effectiveness of MLS, with or without AA, we assessed the fina l outcome regarding the presence and degree of aspiration, diet, history of aspiration pneumonia, and decannulation. Results. Seventy patients underwent 77 MLS (three bilateral, four revisions ), and 21 AA. Decreased aspiration was obtained in 96% of our patients. Sev enty-five percent of those patients who had required a tracheotomy were dec annulated. Conclusions. These results support the use of laryngeal framework surgery f or the effective treatment of aspiration in selected patients initially see n with deficits of the glottic closure secondary to vocal fold paralysis or paresis. (C) 1999 John Wiley & Sons, Inc.