Long-term results of laryngeal suspension and upper esophageal sphincter myotomy as treatment for life-threatening aspiration

Objectives: We evaluated the long-term results of laryngeal suspension and upper esophageal sphincter (UES) myotomy in patients with life-threatening aspiration. Methods: In the period 1995 to 2004, 17 patients with severe aspiration caused by insufficient laryngeal elevation and absent or negligible pharyngeal constrictor muscle activity during deglutition resulting in aspiration pneumonia were surgically treated with a laryngeal suspension procedure and UES myotomy. Preoperative and postoperative video-fluoroscopy was performed to assess swallowing and aspiration. Results: In 9 of the 17 patients, long-term (more than 1 year) full oral intake without aspiration was achieved. Three other patients demonstrated improvement of deglutition with partial restoration of oral intake with adjusted food consistency, but remained partly dependent on gastrostomy feeding for adequate nutrition. Two patients no longer had cases of aspiration pneumonia, but were unable to achieve even modified oral intake. Three patients finally underwent total laryngectomy - 2 of them after initial successful full oral intake without aspiration but with recurrent aspiration as a result of progression of neuromuscular disease. None of the patients succumbed to aspiration pneumonia. Conclusions: In most of our patients, life-threatening aspiration was successfully treated by UES myotomy and laryngeal suspension with restoration of oral intake.