Preventive Surgery against Aspiration Suitable for Tracheal Cannula Management: Cricoid Cartilage-Preserving Type Glottic Closure

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  • Inagi Kanae
    Department of Otolaryngology-Head and Neck Surgery, Sano Kosei General Hospital
  • Okubo Keisuke
    Department of Otolaryngology-Head and Neck Surgery, Sano Kosei General Hospital
  • Kurita Akihiro
    Department of Otorhinolaryngology, Saitama Red Cross Hospital
  • Endo Ayako
    Department of Otorhinolaryngology, Saitama Red Cross Hospital
  • Tomioka Takuya
    Department of Otorhinolaryngology, Yokohama Municipal Citizen's Hospital
  • Shimanuki Marie
    Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine
  • Sugano Yuki
    Department of Otolaryngology, Nippon Koukan Hospital and Koukan Clinic
  • Toshikuni Keitaro
    Department of Otorhinolaryngology, Saitama Red Cross Hospital
  • Fujii Yuzu
    Department of Otorhinolaryngology, Yokohama Municipal Citizen's Hospital
  • Okada Takashi
    Department of Otolaryngology, Japanese Red Cross Shizuoka Hospital
  • Kasahara Ken
    Department of Otolaryngology, Saiseikai Utsunomiya Hospital
  • Minami Ryuji
    Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine
  • Suda Satoshi
    Department of Otolaryngology-Head and Neck Surgery, Sano Kosei General Hospital
  • Ozawa Hiroyuki
    Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine

Bibliographic Information

Other Title
  • 気管カニューレ管理に適した誤嚥防止手術：輪状軟骨温存型声門閉鎖術
  • キカン カニューレ カンリ ニ テキシタ ゴエンボウシ シュジュツ : リンジョウ ナンコツ オンゾンガタ セイモン ヘイサジュツ

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Abstract

<p>Preventive surgery against aspiration is performed to separate the airway from the esophagus as a surgical treatment for severe dysphagia, such as recurrent pneumonia caused by aspiration of saliva. Preventive surgery against aspiration such as glottic closure (Kano's method) is usually performed to create a permanent tracheal stoma which is tube-free; however, patients requiring assisted ventilation for their underlying disease often require a cuffed tracheostomy tube. The tracheostomy tube is designed to fit correctly into the tracheostomy hole, so that it does not usually fit into a permanent tracheal stoma. Cannula incompatibility after aspiration prevention surgery increases the risk of serious complications such as tracheal cannula dislodgement and tracheo-innominate artery fistula compared with tracheostomy. We modified glottic closure surgery (Kano's method), performing what we call “cricoid cartilage-preserving type glottic closure,” in which we shaped the permanent tracheal stoma such that it became closer in shape and dimensions to a tracheostomy hole by preserving the cricoid cartilage. To date we have performed our surgery in seven cases in patients who require a tracheostomy tube for ventilatory management. We evaluated the radius of curvature of the permanent tracheal stoma using sagittal computed tomographic images and compared the radius of curvature of the permanent tracheal stoma by our surgery with glottic closure (Kano's method). We found that the radius of curvature obtained by our surgery was closer to the radius of curvature of the tracheostomy tube than that obtained by glottic closure (Kano's method). There have been no serious complications to date. “Cricoid cartilage-preserving type glottic closure” is useful as a preventive surgery against aspiration in patients who require a tracheostomy tube for ventilatory management.</p>

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