Laryngotracheal separation in neonatal brainstem dysfunction

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• 作者：G. Cariou Patron^a ; ^b ; ^{gwcariou@yahoo.fr} ; N. Teissier^a ; O. Malard^b ; T. Van Den Abbeele^a
• 关键词：Neonatal brainstem dysfunction ; Laryngotracheal separation ; Vocal loss
• 刊名：European Annals of Otorhinolaryngology, Head and Neck Diseases
• 出版年：2010
• 出版时间：March 2010
• 年：2010
• 卷：127
• 期：1
• 页码：23-26
• 全文大小：295 K

文摘

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Summary

Introduction

Neonatal brainstem dysfunction (NBD) associates four symptoms of variable presence and intensity: suction-swallowing dysfunction, abnormal laryngeal sensitivity and motility, gastroesophageal reflux, and cardiac vagal overactivity.

Materials and methods

We report three cases of severe NBD with chronic aspiration which required surgical management. Successive failures and clinical deterioration led us to perform laryngotracheal separation. The surgical procedure consisted in suturing the distal segment of the trachea to the cervical skin after complete closure of the larynx.

Results

After surgery, these children did not present any pulmonary infection and were allowed oral nutrition. However, oral communication was no longer possible. Although it is a theoretically reversible procedure, the decision is ethically difficult in children free of mental deficiency, because of the vocal loss and the unpredictable NBD outcome.

Conclusion

Laryngotracheal separation may be recommended after multidisciplinary decision for severe chronic aspiration in the particular case of children presenting with NBD.