66 CHRONIC ASPIRATION

Question 1

Most common cause of chronic aspiration in adult patients

Answer 1

Cerebrovascular accident with lower cranial nerve palsies

Question 2

Initial conservative treatment of chronic aspiration:

Answer 2

NPO

alternative route of alimentation

Elevation of head of bed

Aggresive pulmonary toilette

Antibiotics for any infectious complications

Question 3

Surgical options for chronic aspiration if NO chance of recovery of Neurologic function:

Answer 3

Subperichondrial cricoidectomy

Narrow - field laryngectomy

Question 4

Surgical options for chronic aspiration if recovery is possible:

Answer 4

Tracheoesophageal diversion

Laryngotracheal separation

Question 5

Tracheoesophageal diversion procedure:

Answer 5

Horizontal division of the trachea at the 4th and 5th tracheal rings.

Proximal end anastomosed end - to - side fashion in anterior esophagus, distal tracheal segment used to create tracheostoma.

Question 6

Laryngotreacheal separation procedure:

Option for patients who had undergone ________, preventing establishment of _______

Answer 6

Division of tarchea horizontally between 2nd and 3rd tracheal rings, or at level of an existing tracheostomy.

Proximal edges closed onto themselves as blind pouch.

Tracheal closure buttressed with rotated sternothyroid muscle.

Distal segment used to create a tracheostoma.

Options…

1. High tracheostomy
2. Tracheoesophageal anastomosis, as performed in TED