| Abstract: | We describe a procedure to plicate the epiglottis into a vertical tube to prevent soiling of the airway due to intractable aspiration. The procedure is combined with an extensive cricopharyngeal myotomy. This technique allows laryngeal speech, even with a tracheostomy, and in some patients may allow the reversal of the tracheostomy. It is only suitable for a small proportion of patients with marked aspiration, as most will respond to conservative treatment. Nine patients underwent this operation and six gained a satisactory result, with two patients achieving tracheostomy reversal. There were two late post-operative deaths from infective causes which reflects the general debiliation of these patients and the risk of exacerbating concomitant broncho-pulmonary infection. |
