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Ueha R, Magdayao RB, Koyama M, Sato T, Goto T, Yamasoba T. Aspiration prevention surgeries: a review. Respir Res 2023; 24:43. [PMID: 36747240 PMCID: PMC9901145 DOI: 10.1186/s12931-023-02354-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and various aspiration prevention surgeries have been introduced, but little is known about them or their benefits. This is a review of the types of aspiration prevention surgery, with the aim of increasing aspiration prevention surgery awareness and their clinical outcomes among medical professionals, which will guide the choices of aspiration prevention surgeries for patients with intractable aspiration. MAIN BODY Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50-80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency. CONCLUSIONS In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.
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Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan. .,Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Redentor B. Magdayao
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan ,Department of Otorhinolaryngology-Head and Neck Surgery, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Misaki Koyama
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Murakami D, Miyamaru S, Nishimoto K, Ise M, Samejima Y, Ozasa S, Nakamura K, Orita Y. Therapeutic outcomes of laryngeal closure and laryngostomy in children with recurrent pneumonia. Int J Pediatr Otorhinolaryngol 2022; 160:111225. [PMID: 35797922 DOI: 10.1016/j.ijporl.2022.111225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/15/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Children with medical complexity frequently experience difficulty breathing and swallowing and occasionally develop aspiration pneumonia. Long-term intubation may cause fatal trachea-innominate artery fistula (TIF). In the present study, we retrospectively evaluated the efficacy of laryngeal closure and laryngostomy in children with medical complexity. MATERIALS AND METHODS Laryngeal closure and laryngostomy were performed in eight children with severe neuromuscular disorders who were incapable of oral ingestion and verbal communication. The laryngostoma was placed at a higher position compared to that in conventional tracheostomies for easier management of the airway and to prevent TIF. RESULTS Aspiration was successfully prevented postoperatively in all cases. Laryngocutaneous fistula formation was not observed. Two patients successfully achieved oral ingestion capability and tracheal cannulas were removed in two patients. Among the six patients who needed a mechanical ventilator before surgery, two patients were weaned from mechanical ventilation. Five patients were successfully discharged from the hospital. Although two patients died because of their primary condition, pneumonia exacerbation was not observed in any of the patients. CONCLUSION Compared to the conventional tracheostomy, our procedure improved airway management and function in children with medical complexity and reduced the risk of TIF.
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Affiliation(s)
- Daizo Murakami
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, Japan.
| | - Satoru Miyamaru
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, Japan
| | - Kohei Nishimoto
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, Japan
| | - Momoko Ise
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, Japan
| | | | - Shiro Ozasa
- Pediatrics, Kumamoto University Hospital, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Japan
| | - Yorihisa Orita
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, Japan
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Begley KA, Braswell LE, Noritz GH, Murakami JW. Salivary gland ablation: introducing an interventional radiology treatment alternative in the management of sialorrhea. Pediatr Radiol 2020; 50:869-876. [PMID: 32198665 PMCID: PMC7217813 DOI: 10.1007/s00247-020-04649-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/22/2019] [Accepted: 02/20/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sialorrhea is common in children with neurological disorders and leads to social isolation, aspiration pneumonia and increased caregiver burden. Sialorrhea management includes anticholinergic medications and a variety of surgeries, but these are limited by side effects, recurrence and risks. OBJECTIVE We present our method of salivary gland ablation, an interventional radiology treatment for sialorrhea, and report safety and efficacy data from pediatric patients who underwent salivary gland ablation. MATERIALS AND METHODS Salivary gland ablation uses image-guided sotradecol and ethanol dual-drug injection into the salivary glands. Submandibular and sublingual glands are injected percutaneously using ultrasound. Parotid glands are injected retrograde through Stensen ducts using fluoroscopy. We conducted a retrospective review of the medical records of patients who underwent salivary gland ablation at our institution between 2005 and 2019. Pre- and post-procedure Drooling Frequency and Drooling Severity (DFDS) scale scores were compared and caregiver satisfaction was assessed. We devised two cohorts, one to study patient safety and a subcohort to study clinical efficacy using DFDS scores. RESULTS One hundred and seventy salivary gland ablation procedures were performed in the 99 patients comprising the safety cohort. Of the procedures, 88.8% resulted in no or minimal complications. Respiratory difficulty, temporary nerve palsy and infection represent the majority of the 11.2% of patients who experienced periprocedural complications. There were no complications resulting in permanent sequelae. Twenty-seven patients met our inclusion criteria for the efficacy subcohort with a mean follow-up time of 5.4 years. DFDS at follow-up decreased from a median score of nine to a seven post-procedure (P=0.000018). The proportion of caregivers who were satisfied with the procedure increased as more glands were ablated, which suggests a causal link between the number of glands ablated and the outcome. CONCLUSION Salivary gland ablation is a safe and effective procedure with the potential for permanent decrease in symptoms related to sialorrhea.
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Affiliation(s)
- Katherine A. Begley
- grid.261331.40000 0001 2285 7943The Ohio State University College of Medicine, Columbus, OH USA
| | - Leah E. Braswell
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Garey H. Noritz
- grid.240344.50000 0004 0392 3476Department of Complex Care, Nationwide Children’s Hospital, Columbus, OH USA
| | - James W. Murakami
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
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Ma Y, Naunheim MR, Gregory J, Woo P. Transoral Tubed Supraglottoplasty: A New Minimally Invasive Procedure for Aspiration. Ann Otol Rhinol Laryngol 2019; 128:1122-1128. [DOI: 10.1177/0003489419862581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:We describe a new procedure for aspiration called tubed supraglottoplasty (TS). TS is a transoral procedure that approximates the aryepiglottic (AE) folds and arytenoids. This narrows the laryngeal inlet. This procedure has been used to improve swallowing and reduce aspiration in patients with vocal fold paralysis. We describe the technical aspects of TS and report on 11 patients.Methods:TS is done by oral intubation followed by suspension laryngoscopy. An incision is made along the AE fold into the posterior commissure and then continued to the opposite AE fold. Dissection within this incision creates two mucosal flaps, one based on the laryngeal surface and the other on the pharyngeal surface. Two 1-cm releasing incisions are made at each end of the AE fold. The laryngeal mucosal flap is approximated using a 3-0 self-locking running suture. The pharyngeal mucosal flap is approximated as a second layer. This double-layered mucosal V-Y advancement flap builds up the posterior laryngeal height. It narrows and “tubes” the supraglottis.Results:All patients tolerated TS without airway complications. Ten of the 11 patients reported improved swallowing function with less aspiration. Six of the 8 patients with prior G-tubes had their gastrostomy tube removed. Postoperative laryngoscopy showed a narrowed “tubed” supraglottis with a higher posterior wall preventing spillover and aspiration. An improved Functional Oral Intake Scale was recorded in ten of eleven patients.Conclusion:TS is a minimally invasive procedure that can improve swallowing and reduce aspiration.
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Affiliation(s)
- Yue Ma
- University of California, Los Angeles, USA
| | | | - Jill Gregory
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Differences in clinical presentation, intraoperative findings and outcome between petroclival and lateral posterior pyramid meningioma. Clin Neurol Neurosurg 2016; 141:122-8. [PMID: 26826961 DOI: 10.1016/j.clineuro.2016.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/29/2015] [Accepted: 01/05/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The goal of this study was to determine the impact of the location of the most frequent skull base meningioma of the posterior fossa, i.e. petroclival (PCM) and lateral posterior pyramid meningioma (LPPM) on clinical presentation, surgical treatment and treatment results. PATIENTS AND METHODS We retrospectively reviewed a consecutive series of patients operated on for PCM (n=46) and LPPM (n=32). Uni- and multivariate analyses were performed to identify differences in clinical presentation, surgical treatment and pre-, intra- and postoperative factors of influence upon the outcome parameters: Complications rate, mortality, tumour recurrence/progress, hospital stay, Karnofsky Performance Score (KPS). RESULTS At Presentation, the rate of dizziness was higher in LPPM (56% vs. 7%, p<0,001) and trigeminal nerve impairment was more frequent in PCM (50% vs. 3%, p<0,001). Complete tumour resections were more often achieved (91% vs. 39%, p<0,001), and surgery lasted shorter (median: 247 min vs. 500 min, p<0,001) with less blood loss (median: 525 ml vs. 1000 ml, p<0,001) in LPPM compared to PCM. The overall complication rates (73% vs. 31%, p<0,001) as well the rate of irreversible complications (57% vs. 9%, p<0,004) were higher in PCM than in LPPM. The most frequent complications of PCM surgery were eye movement (46% vs. 6%, p<0,001), facial nerve (28% vs. 3%, p<0.02) and swallowing impairments (21% vs. 3%, p<0.02). The perioperative mortality was 11% in PCM and 0% in LPPM patients. In the multivariate analyses, KPS at discharge correlate positively with age (p=0.034) and preoperative KPS (p=0.0048) in LPPM and positively with staged resection (p=0.056) and negatively with the occurrence of surgical complications (p=0,0427) in PCM. Hospitalization time correlated with the blood loss (p<0,001) for PCM, negatively with the preoperative KPS (p=0.0002) for PCM and LPPM and positively with tumour diameter (p=0.0001) and non-surgical complications rate (p=0.0001) for LPPM. CONCLUSION As compared to LPPM, surgical treatment of PCM is associated with higher morbidity and mortality. The outcome of LPPM was primarily influenced by preoperative factors: Patients age, tumour size, preoperative KPS. The outcome of PCM was primarily influenced by intraoperative factors like: blood loss, surgery duration, staged tumour resection and the surgical complications rate.
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Bonte K, Huvenne W, De Loof M, Deron P, Viaene A, Duprez F, Vermeersch H. Secondary Voice Restoration After Laryngotracheal Separation (LTS) for Dysphagia with Intractable Aspiration. Dysphagia 2015; 30:695-701. [DOI: 10.1007/s00455-015-9646-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
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Takano K, Kurose M, Mitsuzawa H, Nagaya T, Himi T. Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation for aspiration in patients with severe motor and intellectual disability. Acta Otolaryngol 2015. [PMID: 26211394 DOI: 10.3109/00016489.2015.1067905] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Tracheoesophageal diversion (TED) and laryngotracheal separation (LTS) can prevent aspiration pneumonia and improve the morbidity of patients with severe motor and intellectual disability (SMID). By improving hospitalization rates and care needs, the quality-of-life can be improved for the patients and their parents. OBJECTIVES This study evaluated the clinical outcomes of TED and LTS in patients with intractable aspiration and SMID. METHODS This study retrospectively reviewed patients with SMID and intractable aspiration pneumonia who underwent TED or LTS at the institution between January 2008 and January 2015. It assessed the frequency of sputum suctioning, the number of pre-operative and post-operative hospitalizations, the operative time, and complications. RESULTS Forty patients were identified during the study period. After surgery, there were significant reductions in the frequency of secretion suctioning (from 165.0 times/day to 33.0 times/day) and the number of hospitalizations because of aspiration pneumonia (from 5.4 times/year to 0.2 times/year). A tracheocutaneous fistula occurred in one (2.5%) patient, and two (5.4%) patients developed tracheoinnominate artery fistulas. In the latter group, the innominate arteries were successfully ligated and endovascular embolization was performed.
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Affiliation(s)
- Kenichi Takano
- a 1 Department of Otolaryngology, Sapporo Medical University School of Medicine , Sapporo, Japan
| | - Makoto Kurose
- a 1 Department of Otolaryngology, Sapporo Medical University School of Medicine , Sapporo, Japan
| | - Hiroaki Mitsuzawa
- b 2 Department of Otolaryngology, Hokkaido Medical Center for Child Health and Rehabilitation , Sapporo, Japan
| | - Tomonori Nagaya
- a 1 Department of Otolaryngology, Sapporo Medical University School of Medicine , Sapporo, Japan
- b 2 Department of Otolaryngology, Hokkaido Medical Center for Child Health and Rehabilitation , Sapporo, Japan
| | - Tetsuo Himi
- a 1 Department of Otolaryngology, Sapporo Medical University School of Medicine , Sapporo, Japan
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McCormick ME, Reilly BK, Murnick JG, Bedwell JR. Laryngotracheal separation in an infant with severe dysgenesis of the larynx. Laryngoscope 2014; 124:2186-9. [PMID: 24723435 DOI: 10.1002/lary.24710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/25/2014] [Accepted: 04/07/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS We describe management of an infant with chronic aspiration as a result of severe and rarely described laryngeal dysgenesis. RESULTS A neonate with severe maldevelopment of the laryngeal structures required tracheostomy for respiratory distress on day-of-life 1, but the patient continued to have aspiration pneumonias. After failing to improve with conservative measures, the infant underwent laryngotracheal separation (LTS), which was successful in preventing aspiration. The patient has had no further pneumonias. CONCLUSIONS The presented case illustrates that LTS may be considered a safe and effective initial treatment option for chronic aspiration in select infants with severe dysgenesis of the larynx.
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Affiliation(s)
- Michael E McCormick
- Division of Pediatric Otolaryngology, Medical College of Wisconsin and Children's Hospital of Washington, Milwaukee, Wisconsin
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Alvo A, Olavarría C. Decannulation and Assessment of Deglutition in the Tracheostomized Patient in Non-Neurocritical Intensive Care. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2013.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration. Eur Arch Otorhinolaryngol 2013; 271:1149-55. [DOI: 10.1007/s00405-013-2725-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
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Alvo A, Olavarría C. Decannulation and assessment of deglutition in the tracheostomized patient in non-neurocritical intensive care. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 65:114-9. [PMID: 23510902 DOI: 10.1016/j.otorri.2013.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/06/2013] [Accepted: 01/13/2013] [Indexed: 10/27/2022]
Abstract
With intensive care patients, decannulation and deglutition disorders are frequent reasons for otorhinolaryngological assessment. The objective of a tracheostomy is to maintain a patent airway. It does not necessarily prevent episodes of aspiration and may even favour them. When the cause that led to the tracheostomy resolves, a decannulation may be proposed. Deglutition is a complex act involving the coordinated interaction of several structures of the aerodigestive tract. Fibre-optic endoscopy and videofluoroscopy are 2 useful, complementary tools for the evaluation of patients with swallowing disorders. In managing these patients, a thorough knowledge of laryngeal and swallowing physiology, as well as of the different therapeutic alternatives, is required. Although it is not uncommon for swallowing disorders to coexist in tracheostomy patients, decannulation evaluation is not synonymous with deglutition assessment. A patient could be a candidate for decannulation and have a swallowing disorder, or a tracheostomy patient could swallow adequately. Knowing and understanding these concepts will lead to more efficient management and help to clarify communication between the intensive care physician and the otorhinolaryngologist. Ideally, a multidisciplinary team should be formed to evaluate and manage these patients.
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Affiliation(s)
- Andrés Alvo
- Servicio de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Christian Olavarría
- Servicio de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile
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Chida I, Tamura K, Nakagawa SI, Ando M, Kuno E, Hoshikawa H, Mori N, Takeda N. Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation in neurologically impaired children. Auris Nasus Larynx 2012; 40:383-7. [PMID: 23265577 DOI: 10.1016/j.anl.2012.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/16/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Outcomes of tracheoesophageal diversion and laryngotracheal separation were evaluated in 15 neurologically impaired children treated for intractable aspiration. METHODS A retrospective analysis of the hospital records was carried out in 15 consecutive pediatric patients who underwent either tracheoesophageal diversion or laryngotracheal separation with trumpet-shaped tracheotomy from 1999 to 2006 in Kagawa Children's Hospital. RESULTS The number of hospital admissions for aspiration pneumonia after surgery was significantly decreased in 6 patients who were cared for at home. The parent-reported number of secretion suctioning was decreased after surgery especially in patients with pre-operative tracheotomy or intubation. Four patients fed through naso-gastric tube progressed with oral diet post-operatively, whereas 3 patients who had pre-operative tracheotomy developed temporary post-operative tracheocutaneous fistula that was managed by local wound care. CONCLUSION It is suggested that tracheoesophageal diversion and laryngotracheal separation decrease the morbidity of pediatric patients and improve their quality of life and that of their parents. It is suggested that the risk of developing post-operative fistula is higher in pediatric patients with than without pre-operative tracheotomy.
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Affiliation(s)
- Izumi Chida
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima 770-8503, Japan
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Karli R, Alacam H, Duran L, Alici O, Kati C, Karli A, Guzel A. Analysis of the protective biochemical and pathologic effects of aminoguanidine on an experimental aspiration pneumonitis model induced by bile acids. Curr Ther Res Clin Exp 2012; 73:207-19. [PMID: 24653522 DOI: 10.1016/j.curtheres.2012.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux (GER) is a common clinical pathology detected in childhood. Bile acids (BAs) are present in reflux and cause various pathologies in the esophagus, the larynx, and the lungs. OBJECTIVE We aimed to show if aminoguanidine (AG) contributes to the biochemical and histopathologic treatment of experimental aspiration pneumonitis induced by BAs. METHODS Twenty-eight female Sprague Dawley rats were used. There were 4 groups in the study: (1) group aspirated with 0.9% saline (n = 7), (2) group aspirated with 0.9% saline and treated with AG (n = 7), (3) group aspirated with a solution of 10 mg/kg taurocholic acid and 5 mg/kg taurochenodeoxycholate (n = 7), and (4) group aspirated with BA and treated with AG (n = 7). The saline and BA solutions were administered as 1 mL/kg intratracheally. The AG was administered intraperitoneally twice a day at a 150 mg/kg dose for 7 days. The different histopathologic and biochemical parameters were analyzed. RESULTS Clara cell protein 16 and malondialdehyde levels were found to be significantly higher in the BA group than in the group where saline was administered; however, they were significantly lower in the BA + AG group than in the BA group. The total superoxide dismutase activity decreased significantly in the BA group compared with the group where saline was administered. A significant increase in superoxide dismutase activity was observed in the BA + AG group when compared with the group where only BA was administered. When the group where BA was administered solely was compared with the group where saline was administered, peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar histiocytes, interstitial fibrosis, and granuloma were significantly higher in the BA group than in the saline group. When the BA + AG group was compared with the BA group, peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar histiocytes, interstitial fibrosis, and granuloma were found to be significantly lower. CONCLUSIONS Oxidant stress increases and antioxidant capacity decreases in pneumonitis induced by BAs. AG administration as an antioxidant helps in recovery, both biochemically and histopathologically. Consequently, AG seems to be an alternative that should be considered in a conservative approach to treating aspiration pneumonitis.
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Affiliation(s)
- Rifat Karli
- Department of Otorhinolaryngology, Ondokuz Mayis University, Samsun, Turkey
| | - Hasan Alacam
- Department of Medical Biochemistry, Ondokuz Mayis University, Samsun, Turkey
| | - Latif Duran
- Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Omer Alici
- Department of Pathology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Celal Kati
- Department of Otorhinolaryngology, Ondokuz Mayis University, Samsun, Turkey
| | - Arzu Karli
- Department of Pediatric Infection, Ondokuz Mayis University, Samsun, Turkey
| | - Ahmet Guzel
- Department of Pediatrics, Ondokuz Mayis University, Samsun, Turkey
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Laryngotracheal separation surgery for intractable aspiration: our experience with 12 patients. Int J Pediatr Otorhinolaryngol 2011; 75:931-4. [PMID: 21570131 DOI: 10.1016/j.ijporl.2011.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/08/2011] [Accepted: 04/09/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Laryngotracheal separation surgery (LTS) was performed as a treatment for recurrent or intractable aspiration pneumonia in 12 pediatric patients. The effectiveness of LTS surgery for preventing aspiration pneumonia, and the complications of this procedure were investigated. METHODS A retrospective chart review, conducted at a tertiary academic hospital in conjunction with a private practice, was used to identify children who underwent Laryngotracheal Separation Surgery (LTS) from September 2001 to July 2007. The main outcome measure was the number of hospital admissions for pneumonia in the pre LTS and post LTS period. A student's t-test was used for statistical analysis. RESULTS LTS surgery decreased the frequency of pulmonary infections and respiratory events in all patients, resulting in far fewer hospitalizations. These patients experienced an average of 5 hospital admissions for pneumonia in the 2 years prior to LTS surgery, and an average of 1.1 hospital admissions for pneumonia after the LTS surgery. There were no major complications related to the surgery. Several minor complications following surgery were easily and effectively dealt with in the perioperative period. CONCLUSIONS LTS surgery is an effective and safe procedure in children with intractable aspiration. Parents do not perceive the care of the LTS stoma as burdensome. This procedure should be considered as an option in the surgical intervention for the management of chronic aspiration pneumonia in severely neurologically impaired children.
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Abstract
INTRODUCTION Neonatal brainstem dysfunction (NBD) associates four symptoms of variable presence and intensity: suction-swallowing dysfunction, abnormal laryngeal sensitivity and motility, gastroesophageal reflux, and cardiac vagal overactivity. MATERIALS AND METHODS We report three cases of severe NBD with chronic aspiration which required surgical management. Successive failures and clinical deterioration led us to perform laryngotracheal separation. The surgical procedure consisted in suturing the distal segment of the trachea to the cervical skin after complete closure of the larynx. RESULTS After surgery, these children did not present any pulmonary infection and were allowed oral nutrition. However, oral communication was no longer possible. Although it is a theoretically reversible procedure, the decision is ethically difficult in children free of mental deficiency, because of the vocal loss and the unpredictable NBD outcome. CONCLUSION Laryngotracheal separation may be recommended after multidisciplinary decision for severe chronic aspiration in the particular case of children presenting with NBD.
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Tatekawa Y, Hosino N, Hori T, Kaneko M. Closure of the larynx for intractable aspiration in neurologically impaired patients. Pediatr Surg Int 2010; 26:553-6. [PMID: 20383513 DOI: 10.1007/s00383-010-2567-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2010] [Indexed: 11/27/2022]
Abstract
We present three patients with intractable aspiration pneumonia in the setting of permanent neurologic impairment, who had received a tracheostomy and showed a juxtaposition of the innominate artery against the trachea. Neurologically impaired patients often show a juxtaposition or compression of the innominate artery against the trachea by chest deformity in the setting of severe scoliosis, which could result in a trachea-innominate artery fistula. For intractable aspiration, laryngotracheal separation is safely performed and effective in controlling aspiration, but is occasionally complicated by trachea-innominate artery fistula. As an alternative procedure, we performed a closure of the larynx in these three cases, using double flaps of the vocal folds and false vocal folds, as a treatment for intractable aspiration. After operation, the patients did well without complication or clinical evidence of recurrent aspiration.
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Affiliation(s)
- Yukihiro Tatekawa
- Department of Pediatric Surgery, Graduate School of Comprehensive Human Sciences and University Hospital, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan.
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Guven M. Definitive techniques for intractable aspiration pneumonia. Int J Pediatr Otorhinolaryngol 2006; 70:1321; author reply 1322-3. [PMID: 16707166 DOI: 10.1016/j.ijporl.2006.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 03/30/2006] [Indexed: 11/21/2022]
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