Definitive techniques for intractable aspiration pneumonia
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LETTER TO THE EDITOR Definitive techniques for intractable aspiration pneumonia To the Editor, Though we read with great interest the article by Hafidh et al. [1], there are concerns regarding the conclusion drawn by the authors about the treat- ment of intractable aspiration. The authors suggest that laryngotracheal separa- tion operation is the best technique for these patients. In order to suggest such a conclusion, large patients series should be handled. Other definitive techniques applied to these patients have similar advantages. In such patients, the simplicity and relia- bility of the procedure is the most important factor. For patients with intractable aspiration who have no chance of recovery of laryngeal function surgical procedures should be definitive as laryngotracheal separation or tracheoesophageal diversion, total laryngectomy, supraglottic closure, glottic closure and triple-layer laryngeal closure [2,3]. Literature review has revealed that the supraglottic closure is also associated with a high failure rate [4]. Hafidh et al. report a high postoperative phar- yngocutaneous fistula rate after total laryngectomy operation. Literature review indicates that there is higher postoperative pharyngocutaneous fistula rate after laryngotracheal separation operation [5,6]. The procedure should be definitive with low postoperative complication rates and be reliable and simple. Patients with intractable aspiration usually have many systemic diseases and impaired respiratory function. These patients also have high risk for general anaesthesia and pharyngocutaneous fistula postoperatively. In conclusion, laryngotracheal separation may be a good choice for these patients. Howewer, we believe that more reliable surgical procedures with less complication rates are essential for surgical treatment of intractable aspiration. So, extensive experimental and clinical research series are needed for this matter. References [1] M.A. Hafidh, O. Young, J.D. Russell, Intractable pulmonary aspiration in children: which operation? Int, J. Pediatr. Otor- hinolaryngol. 70 (2006) 19—25. [2] R.F. Miller, I. Eliachar, Managing the aspirating patient, Am. J. Otolaryngol. 15 (1994) 1—17. [3] G. Mehmet, I. Ibrahim, E. Ahmet, K. Yuksel, Triple-layer laryngeal closure for intractable aspiration, J. Laryngol. Otol. 119 (2005) 564—566. [4] D.W. Eisele, Surgical approaches to aspiration, Dysphagia 6 (1991) 71—77. [5] D.E. Eibling, C.H. Snyderman, C. Eibling, Laryngotracheal separation for intractable aspiration: a retrospective review of 34 patients, Laryngoscope 105 (1995) 83—85. [6] T. Yamana, H. Kitano, M. Hanamitsu, K. Kitajima, Clinical outcome of laryngotracheal separation for intractable aspira- tion pneumonia, ORL 63 (2001) 321—324. Mehmet Guven* Gaziosmanpasa University Faculty of Medicine, Department of Otorhinolaryngology, Tokat, Turkey *Tel.: +9 356213 31 79; fax: +9 356213 31 79 E-mail address: [email protected] 24 November 2005 International Journal of Pediatric Otorhinolaryngology (2006) 70, 1321 www.elsevier.com/locate/ijporl KEYWORDS Intractable aspiration; Laryngotracheal separation; Definitive techniques DOI of related article: 10.1016/j.ijporl.2006.03.017. 0165-5876/$ — see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2006.03.016
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Transcript of Definitive techniques for intractable aspiration pneumonia
LETTER TO THE EDITOR
International Journal of Pediatric Otorhinolaryngology (2006) 70, 1321
www.elsevier.com/locate/ijporl
Definitive techniques for intractable aspirationpneumonia
KEYWORDSIntractable aspiration;Laryngotrachealseparation;Definitive techniques
To the Editor,
Though we read with great interest the article byHafidh et al. [1], there are concerns regarding theconclusion drawn by the authors about the treat-ment of intractable aspiration.
The authors suggest that laryngotracheal separa-tion operation is the best technique for thesepatients. In order to suggest such a conclusion, largepatients series should be handled. Other definitivetechniques applied to these patients have similaradvantages. In suchpatients, the simplicity and relia-bility of the procedure is the most important factor.
For patients with intractable aspiration who haveno chance of recovery of laryngeal function surgicalprocedures should be definitive as laryngotrachealseparation or tracheoesophageal diversion, totallaryngectomy, supraglottic closure, glottic closureand triple-layer laryngeal closure [2,3]. Literaturereview has revealed that the supraglottic closure isalso associated with a high failure rate [4].
Hafidh et al. report a high postoperative phar-yngocutaneous fistula rate after total laryngectomyoperation. Literature review indicates that there ishigher postoperative pharyngocutaneous fistularate after laryngotracheal separation operation[5,6]. The procedure should be definitive with lowpostoperative complication rates and be reliable
DOI of related article: 10.1016/j.ijporl.2006.03.017.
0165-5876/$ — see front matter # 2006 Elsevier Ireland Ltd. All rigdoi:10.1016/j.ijporl.2006.03.016
and simple. Patients with intractable aspirationusually have many systemic diseases and impairedrespiratory function. These patients also have highrisk for general anaesthesia and pharyngocutaneousfistula postoperatively.
In conclusion, laryngotracheal separation may bea good choice for these patients. Howewer, webelieve that more reliable surgical procedures withless complication rates are essential for surgicaltreatment of intractable aspiration. So, extensiveexperimental and clinical research series areneeded for this matter.
References
[1] M.A. Hafidh, O. Young, J.D. Russell, Intractable pulmonaryaspiration in children: which operation? Int, J. Pediatr. Otor-hinolaryngol. 70 (2006) 19—25.
[2] R.F. Miller, I. Eliachar, Managing the aspirating patient, Am. J.Otolaryngol. 15 (1994) 1—17.
[3] G. Mehmet, I. Ibrahim, E. Ahmet, K. Yuksel, Triple-layerlaryngeal closure for intractable aspiration, J. Laryngol. Otol.119 (2005) 564—566.
[4] D.W. Eisele, Surgical approaches to aspiration, Dysphagia 6(1991) 71—77.
[5] D.E. Eibling, C.H. Snyderman, C. Eibling, Laryngotrachealseparation for intractable aspiration: a retrospective reviewof 34 patients, Laryngoscope 105 (1995) 83—85.
[6] T. Yamana, H. Kitano, M. Hanamitsu, K. Kitajima, Clinicaloutcome of laryngotracheal separation for intractable aspira-tion pneumonia, ORL 63 (2001) 321—324.
Mehmet Guven*Gaziosmanpasa University Faculty of Medicine,
Department of Otorhinolaryngology, Tokat, Turkey
*Tel.: +9 356213 31 79; fax: +9 356213 31 79E-mail address: [email protected]
24 November 2005
hts reserved.
