Laryngohyoid suspension

Abstract

In patients with chronic severe aspiration and recurrent pneumonia often a strict percutaneous endoscopic gastrostomy (PEG) feeding policy, a total laryngectomy, or any other type of permanent anatomical or functional separation of airway and digestive tract, is performed. However in selected cases it is possible to preserve or restore oral intake with a functional larynx by a laryngohyoid suspension procedure in combination with a UES myotomy. This procedure should be considered if aspiration is caused by a combination of deficient deglutitive laryngeal elevation and anterior movement, lack of pharyngeal constrictor activity, and insufficient opening of the esophageal inlet. By suspending the laryngohyoid complex antero-cranially to the mandible the airway is pulled away from the bolus and is partially covered by the epiglottis diverting the bolus around it. The repositioning of the laryngohyoid complex also pulls the esophageal inlet open providing better drainage in the esophagus and less chance of aspiration from stasis.