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Definitive techniques for intractable aspiration pneumonia
International Journal of Pediatric Otorhinolaryngology (2006) 70, 1321
www.elsevier.com/locate/ijporl
LETTER TO THE EDITOR Definitive techniques for intractable aspiration pneumonia KEYWORDS Intractable aspiration; Laryngotracheal separation; Definitive techniques
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 treatment of intractable aspiration. The authors suggest that laryngotracheal separation 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 reliability 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 pharyngocutaneous 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. Otorhinolaryngol. 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 aspiration 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]
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
24 November 2005
www.elsevier.com/locate/ijporl
LETTER TO THE EDITOR Definitive techniques for intractable aspiration pneumonia KEYWORDS Intractable aspiration; Laryngotracheal separation; Definitive techniques
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 treatment of intractable aspiration. The authors suggest that laryngotracheal separation 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 reliability 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 pharyngocutaneous 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. Otorhinolaryngol. 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 aspiration 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]
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
24 November 2005