Intractable aspiration is a severe and often fatal complication in patients with impaired protective function of the larynx. This problem is usually a result of central nervous system disorders such as cerebrovascular accident, trauma, neoplasms, or degenerative disease. Surgical separation of the upper respiratory tract from the digestive tract can prevent recurrent contamination of the respiratory system in these patients. Two such procedures are the tracheoesophageal diversion procedure and a modification of this operation, the laryngotracheal separation procedure. The Virginia Mason Medical Center experience with these procedures, their indications, technique, and outcome are presented. In addition, cases of successful surgical reversal of the diversion procedures are discussed.
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