Laryngeal suspension and upper esophageal sphincter myotomy as a surgical option for treatment of severe aspiration

Severe aspiration remains a difficult condition to treat without sacrificing the laryngeal functions of respiration and phonation. Upper esophageal sphincter (UES) myotomy as a sole treatment proves to be insufficient in many cases. Deglutative laryngeal elevation can be considered the most important factor responsible for opening of the esophageal inlet during deglutition. Therefore, a combination of laryngeal suspension procedure and a UES myotomy may be an alternative for treatment of severe aspiration without separating the airway and alimentary tract. Laryngeal suspension has in the past been proposed as a reconstructive procedure in major ablative surgery involving the floor of the mouth and the hyoid. Ten patients with severe aspiration and insufficient laryngeal elevation and constrictor pharyngeal muscle activity during deglutition were surgically treated with a laryngeal suspension procedure and upper esophageal sphincter myotomy. Five of the 10 patients had a good result, enabling them to have an oral intake sufficient to fulfill their nutritional needs. Two other patients have improved after the procedure, but are still dependent on gastrostomy feeding. Three patients eventually underwent a total laryngectomy, 2 of them after initial successful prevention of aspiration. In these 2 cases, aspiration recurred as a result of progression of the muscular disease. Life-threatening aspiration can often successfully be corrected by UES myotomy and laryngeal suspension. After a high initial success rate, long-term overall success can be anticipated in approximately 50% of the cases because of relapses in some patients caused by progression of underlying diseases.