A Case of Laryngeal Closure for Dysphagia Following Percutaneous Dilatational Tracheostomy

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In recent years, there are many reports about percutaneous dilatational tracheostomy (PDT). This procedure has been reported as being simple to perform and has less complications. However, we experienced a case in which a tracheostoma stenosis and granulation hyperplasia occurred due to PDT, and dysphagia occurred because of the defective laryngeal elevation. A 79 years old woman presented with disturbance of consciousness due to a subarachnoid hemorrhage and PDT was performed at an intensive care unit. Following the procedure she was quadriplegic with dysphagia and had to continue rehabilitation. Because of the dysphagia and difficulty in the management of the tracheotomy tube, she was referred to us. We selected laryngeal closure as preventive surgery against aspiration, and obtained a good result. PDT complications have also been reported in several studies. As the procedure is performed blindly, the tube may not be placed medially in the trachea or it may happen to break tracheal cartilages. When particularly long-term breathing management is necessary, we think that surgical tracheotomy associated with very few occurrences of tracheostoma stenosis and granulation hyperplasia is desirable. In addition, the operation that we performed was useful because it was hard to make a diastasis and it was easy to make a permanent tracheal stoma. In those patients with a tracheostoma and dysphagia, we would like to recommend a laryngeal closure operation.