Laryngeal framework surgery for the management of aspiration in high vagal lesions

The purpose of this study is to ascertain the effectiveness of laryngeal framework surgery, including medialization thyroplasty (MT), with or without arytenoid adduction (AA), on preventing aspiration, improving diet, and aiding in the subsequent decannulation of individuals with high vagal lesions.

A retrospective chart review was performed on each patient presenting with a high vagal lesion who was treated with laryngeal framework surgery from June 1992 to April 1996 at a university medical center. Thirty-five patients were identified; there were 20 women and 15 men, with a median age of 51. Information regarding etiology of the lesion, characteristics of the vocal cord deficits, degree of aspiration, the presence of other neurologic deficits and concurrent pulmonary disease, treatment, and outcome was obtained. The final outcome regarding voice, the presence and degree of aspiration, diet, and decannulation following MT, with or without AA, was assessed to determine the effectiveness of these procedures.

Thirty-five patients underwent 40 MTs and 19 AAs. Ninety-four percent of patients who experienced aspiration improved, and 79% who had required tracheotomy were decannulated. Ninety percent of patients were noted to have subjective improvement in voice postoperatively.

Laryngeal framework surgery improves airway, deglutition, and voice in individuals suffering from high vagal lesions, and facilitates the rehabilitation of these patients.