Modified laryngotracheal separation for intractable aspiration pneumonia in patients with nasopharyngeal carcinoma treated by radiotherapy

• Published in: Auris, nasus, larynx nasus, larynx, 2013-06, Vol.40 (3), p.298-302
• Main Authors: Lei, Wenbin, Chai, Liping, Guo, Jiebo, Zhu, Yuan-ping, Zhu, Xiaolin, Jiang, Aiyun, Wen, Weiping, Su, Zhenzhong
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma - radiotherapy; Cranial Nerve Diseases - complications; Cranial Nerve Diseases - etiology; Deglutition Disorders - etiology; Deglutition Disorders - surgery; Humans; Intractable aspiration pneumonia; Larynx - surgery; Male; Middle Aged; Modified laryngotracheal separation (MLTS); Nasopharyngeal Neoplasms - radiotherapy; Neck Muscles - transplantation; Nutritional Status; Otolaryngology; Otorhinolaryngologic Surgical Procedures - methods; Pneumonia, Aspiration - etiology; Pneumonia, Aspiration - surgery; Postradiotherapeutic nasopharyngeal carcinoma (PNC); Quality of Life; Radiotherapy - adverse effects; Respiratory Mucosa - surgery; Retrospective Studies; Trachea - surgery
• ISSN: 0385-8146; 1879-1476
• DOI: 10.1016/j.anl.2012.10.002

Abstract Objectives Intractable aspiration pneumonia in patients with postradiotherapeutic nasopharyngeal carcinoma (PNC) is a formidable complication, but has not attracted enough attention in clinical practice. Modified laryngotracheal separation (MLTS) was applied for these patients in our hospital, the surgical effects of which were assessed. Patients and methods Retrospective analysis of 9 PNC cases complicated by intractable aspiration pneumonia in our hospital was carried out. All cases were diagnosed as lower cranial nerve palsy. Their aspiration pneumonia was not effectively prevented or controlled after a series of previous treatments, including active anti-infectives, neurotrophy, acupuncture, nutrition support, nasogastric feeding and tracheotomy. Ultimately all of them received modified laryngotracheal separation (MLTS) surgery. Efficacy of the operation was assessed. Results In all patients, aspiration pneumonia was effectively controlled after the operation, body weights increased more than 6 kg six months later, and nutrition status, swallowing function and quality of life were all improved. Conclusions Intractable postradiotherapeutic aspiration pneumonia in patients with nasopharyngeal carcinoma was possibly caused by lower cranial nerve palsy, which might be related to radiation fields overlapped. Modified laryngotracheal separation is effective in eliminating intractable aspiration in PNC. Suitable patients should be carefully selected although the procedure is potentially reversible.