Laryngeal closure or diversion for aspiration

One of several potential treatments for a person who suffers from gross aspiration to the extent that, even without taking any nourishment by mouth, this person has repeatedly incurred aspiration pneumonia (i.e., due to saliva alone). In this scenario, subsequent pneumonias start to become more severe and even life-threatening as the lungs progressively deteriorate. At this point, there is a list of options:

  1. Tracheotomy. This procedure makes it possible to suction out the trachea and any aspirated secretions on a frequent basis, and to inflate a balloon on the outside of the tube in order to reduce the volume of aspirated secretions.
  2. Tracheal transection, with or without diversion. This option deprives the person of voice and makes him or her an obligate neck breather. In this procedure, a physician transects the trachea and sews the stump below the larynx completely shut. The lower stump is sewn to the skin, making the person a neck breather. If the person’s ability to swallow returns, then theoretically the trachea can be reattached. A variant of this procedure is to sew the upper stump into the esophagus so that secretions that enter the larynx can drain into the esophagus.
  3. Total laryngectomy. This option is the most definitive way to stop life-threatening aspiration. Its best application is in an individual whose ability to swallow is certain not to recover. Total laryngectomy consigns the person to neck breathing (like option 2), but a tracheoesophageal voice can be established and swallowing becomes perfectly safe, because the airway and foodway are completely separated.