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‘Steam-boat’ supraglottic laryngoplasty for treatment of chronic refractory aspiration: a modification of Biller's technique

Published online by Cambridge University Press:  01 July 2009

P K M Ku ,
V J Abdullah ,
A C Vlantis ,
K Y S Lee ,
A C van Hasselt  and
M C F Tong
P K M Ku
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
V J Abdullah
Affiliation:
Department of Ear, Nose and Throat, United Christian Hospital, Hong Kong
A C Vlantis
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
K Y S Lee
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
A C van Hasselt
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
M C F Tong*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
*
Address for correspondence: Professor Michael Chi-Fai Tong, Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR. Fax: (852) 26466312 E-mail: mtong@ent.cuhk.edu.hk
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Abstract

Objective:

The surgical treatment of intractable aspiration usually requires sacrifice of the patient's natural voice to prevent food entering the airway. Biller described a tubed supraglottic laryngoplasty to control aspiration while allowing patients to phonate with their larynx. Our preliminary experience with this technique in Chinese patients has been disappointing, as tension in the mucosa on wound closure led to wound dehiscence. Our objective was to modify Biller's technique in order to achieve a better outcome.

Method:

We modified Biller's technique by trimming the epiglottic cartilage and by inserting a tibial periosteal graft to reinforce closure of the mucosa, creating an arrangement resembling a Chinese steam boat.

Results:

Three Chinese patients underwent the modified Biller's technique. No wound dehiscence occurred, the surgery controlled aspiration, and the patients were able to phonate with their own larynx. All patients resumed oral feeding, and previously placed gastrostomy tubes were removed.

Conclusion:

The ‘steam-boat’ supraglottic laryngoplasty is a viable surgical alternative to total laryngectomy or tracheal diversion for controlling intractable aspiration, and preserves a phonating larynx.

Keywords

SurgeryAspirationLaryngoplastyTreatment
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 12 , December 2009 , pp. 1360 - 1363
Copyright
Copyright © JLO (1984) Limited 2009

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