LARYNGEAL FRAMEWORK SURGERY FOR THE MANAGEMENT OF ASPIRATION IN HIGH VAGAL LESIONS

Purpose: The purpose of this study is to ascertain the effectiveness o f laryngeal framework surgery, including medialization thyroplasty (MT ), with or without arytenoid adduction (AA), on preventing aspiration, improving diet, and aiding in the subsequent decannulation of individ uals with high vagal lesions. Patients and Methods: A retrospective ch art review was performed on each patient presenting with a high vagal lesion who was treated with laryngeal framework surgery from June 1992 to April 1996 at a university medical center. Thirty-five patients we re identified; there were 20 women and 15 men, with a median age of 51 . Information regarding etiology of the lesion, characteristics of the vocal cord deficits, degree of aspiration, the presence of other neur ologic deficits and concurrent pulmonary disease, treatment, and outco me was obtained. The final outcome regarding voice, the presence and d egree of aspiration, diet, and decannulation following MT, with or wit hout AA, was assessed to determine the effectiveness of these procedur es. Results: Thirty-five patients underwent 40 MTs and 19 AAs. Ninety- four percent of patients who experienced aspiration improved, and 79% who had required tracheotomy were decannulated. Ninety percent of pati ents were noted to have subjective improvement in voice postoperativel y. Conclusion: Laryngeal framework surgery improves airway, deglutitio n, and voice in individuals suffering from high vagal lesions, and fac ilitates the rehabilitation of these patients. Copyright (C) 1998 by W .B. Saunders Company.