Ananth VİJENDREN, Liliana JABLENSKA, Prasad KOTHARİ, Aaron TRİNİDADE

The Extended Role of Total Laryngectomy in Patients with Severe Neuromuscular Disabilities

Şiddetli nörolojik bozukluğu olanlarda sayısız probler arasında tekrarlayan hava yolu tıkanmaları ve larinks koruyucu mekanizma disfonksiyonu nedeniyle dirençli aspirasyon pnömonileri yer almaktadır. Burada, bu hastalar için cerrahi bir seçenek olarak total larenjektomi kullanımını tarif edilmektedir. Olgu hava yolu tıkanıklığı ve aspirasyon pnömonisi ataklarıyla gelen ciddi serebral palsili 24 yaşındaki erkek idi. Tekrarlayan aspirasyon pnömoniler ile gelen, özellikle etkili sözlü iletişimin daha önceden aciz olmuş ağır özürlü hastalarda total larenjektomi görülebilir bir seçenek olarak sunulubailir

Anahtar Kelimeler:

Aspirasyon pnömonisi, havayolu tıkanıklığı, nöromuskuler bozukluk, larenjektomi

The Extended Role of Total Laryngectomy in Patients with Severe Neuromuscular Disabilities

Amongst the myriad of problems that patients with severe neurodisability encounter is that of recurrent airway obstructions and intractable aspiration pneumonias due to dysfunction of the protective mechanism of the larynx. It can result in significant morbidity and mortality and represents a large burden for carers and patient alike. Here, we describe the use of total laryngectomy as a surgical option for these patients. Case discussion of a 24 year old male with severe cerebral palsy suffering from recurrent episodes of airway obstruction and aspiration pneumonia. This patient underwent a total laryngectomy with good effect. In addition to relieving his symptoms, it greatly eased the daily management of his airway by his carers. In the severely disabled patient with recurrent aspiration pneumonias, total laryngectomy may present as a viable option, especially in those patients who have been previously incapable of effective verbal communication.

Keywords:

Aspiration pneumonia, airway obstruction, neuromuscular disorder, laryngectomy,

PDF

___

Hawthrone M. Conservative Laryngectomy (An effective treatment for severe aspiration pneumonia in motor neu- ron disease). J Laryngol Otol 1987;101:293-85. 2. Aspiration Pneumonia–Medscape
http://emedicine.medscape.com/article/296198
overview#aw2aab6c29 – Accessed 2012
Blitzer A, Brin M F, Ramig L. Neurological Disorders of the Larynx. Thieme Medical Publishers 2009:89-90
Neuromuscular Disorders – Medline Plus http://www. nlm.nih.gov/medlineplus/neuromusculardisorders.html - Accessed 2012
Montgomery WW. Surgery to prevent aspiration. Arch Otolaryngol. 1975;101:679-82.
Brookes G B, McKelvie P. Epiglottopexy: a new surgical technique to prevent intractable aspiration. Ann R Coll Surg Engl 1983;65:293–6.
Gelfand YM, Duncan NO, Albright JT, et al. Laryngotracheal separation surgery for intractable aspiration: our expe- rience with 12 Patients. Int J Pediatr Otorhinolaryngol 2011;75:931-4.
Francis DO, Blumin J, Merati A. Reducing fistula rates following laryngotracheal separation. Ann Otol Rhinol Laryngol 2012;121:151-5.
Tracheostomy – National Heart Lung and Blood Institute, People Science Health, US Department of Health and Human health-topics/topics/trach/ - Accessed 2012 Reference.
http://www.nhlbi.nih.gov/health/
Takano Y, Suga M, Sakamoto O et al. Satisfaction of pa- tients treated surgically for intractable aspiration. Chest 1999;116:1251-6.