Management of chronic aspiration by subtotal and submucosal cricoid resection

Modern techniques of conservation surgery of the laryngopharynx often result in narrowing, immobility, and decreased sensation of the hypopharynx. These procedures also compromise the most vital function of the larynx--protection of the airway. Permanent tracheostomy is always necessary for protection of the airway. Teflon injection, cartilage implant to the larynx, and extended pharyngeal myotomy can provide only temporary relief. Swallowing studies under fluoroscopy as well as laryngopharyngoscopy verify a narrowed pharyngeal inlet with the pharynx trapped between the cricoid and the cervical spine. Extrapharyngeal, subtotal, submucosal resection of the posterior cricoid ring results in a flaccid posterior laryngeal wall and enlarged hypopharyngeal inlet. At the same time the laryngeal inlet is narrowed, reducing aspiration and still preserving the voice.