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We present a new oral intake route in a hypopharyngeal cancer patient with severe complications. A 64-year-old man was diagnosed as having T2N0M0 squamous cell carcinoma of the posterior wall of the hypopharynx. He had previously undergone radiotherapy for laryngeal cancer and tricuspid valve replacement surgery, and also had atrial flutter and renal dysfunction. We performed surgery with curative intent. The hypopharynx was primarily closed after tumor resection. Laryngotracheal separation and tracheoesophageal diversion with end-to-end anastomosis of the trachea to the esophagus was performed. After surgery, complete oral feeding was achieved using the new pathway created. The larynx, contradictory to its typical role, can be used as a pathway to the esophagus using our revolutionary technique.

Laryngotracheal separation injuries are a rare but serious condition, as survival from such injuries relies on proper airway management. As a result, recommendations for management have been based on small case reports and expert opinion. We reviewed our last 10 years of experience with managing laryngotracheal separation injuries and identified 6 cases for chart review. Awake tracheostomy or videolaryngobronchoscopy was used in each case to initially obtain the airway. Surgical repair was then performed immediately using nonabsorbable monofilament suture or a miniplate, and a low fenestrated tracheostomy was placed. All of our patients who followed up were decannulated, eating regular diets, and had satisfactory voice quality at 3 months postoperatively. Review of the literature revealed that, while management strategies have changed over time, treatment still varies widely depending on surgeon preference and the details of each injury. Outcomes from our series suggest that our described techniques and management strategies can be used with good outcomes. We believe that this is due to securing a safe airway, early surgical intervention with no unnecessary tissue dissection, effective reconstruction of the airway, and the fenestrated tracheostomy technique.

Background Surgery to prevent aspiration has complications related to tracheostomy tube, such as the trachea-brachiocephalic artery fistula. Glottic closure procedure makes tracheostoma at a position higher than the first ring of the trachea and theoretically has a potential to prevent such complications owing to a longer distance between the tip of tracheostomy tube and the tracheal membrane adjacent to the brachiocephalic artery. Our aim is to evaluate the safety of glottic closure in neurologically impaired patients by comparing outcomes with laryngotracheal separation. Methods This study is a single-center retrospective study from 2004 to 2019, using data of 15 and 12 patients who underwent glottic closure (GC) and laryngotracheal separation (LTS). The primary outcome was the incidence of postoperative complications induced by tracheostomy tube placement and adjustment of the tracheostomy tube position to prevent these complications, such as by converting to a length-adjustable tube and/or placing gauze between the skin and tube flange. Additionally, we analyzed the anatomical relationship between the tracheostomy tube tip and brachiocephalic artery and measured the distance between them using postoperative CT images. Results No patients in either group had trachea-brachiocephalic artery fistula. Erosion or granuloma formation occurred in 1 patient (7%) and 4 patients (33%) in the GC and LTS groups, respectively. Adjustment of the tracheostomy tube was needed in 2 patients (13%) and 6 patients (50%) in the GC and LTS groups. CT revealed a higher proportion of patients with the tracheostomy tube tip superior to the brachiocephalic artery in GC than LTS group. The mean tracheostoma-brachiocephalic artery distance was 40.8 and 32.4 mm in the GC and LTS groups. Conclusions Glottic closure reduces the risk of postoperative complications related to a tracheostomy tube. This may be due to the higher position of the tracheostoma at the level of the cricoid cartilage, increasing the distance between the tracheostoma and brachiocephalic artery.

Blunt laryngotracheal injuries are rare. The signs and symptoms of blunt laryngotracheal trauma are not always specific to the extent or type of injury. A high index of suspicion should exist in any injury that may be associated with airway trauma. We report a 30-years man who had progressive shortness of breath following blunt neck injury. He had massive emphysema whereby an emergency tracheostomy with multiple fasciotomy was performed. During emergency tracheostomy, it was noted that he had anterior cricotracheal separation which was communicated posteriorly by mucosa and trachealis muscle. Bangladesh J Otorhinolaryngol; October 2016; 22(2): 114-118

External laryngotracheal trauma is a rare occurrence and requires specialized evaluation and management. Airway compromise from laryngotracheal injury can be catastrophic. The stability of an airway must be ensured with rapid and repeated clinical evaluation. Additionally, bedside and operative endoscopy combined with radiographic studies should guide treatment planning. Repair may include open reduction and internal fixation of laryngeal fractures, endolaryngeal mucosal repair (via either endoscopic or open approaches), endoluminal stenting, or open repair of laryngotracheal separation.

Laryngeal diversion procedures are used for patients with intractable aspiration. These surgeries include laryngotracheal separation (LTS) and tracheoesophageal diversion (TED). Both procedures are potentially reversible and offer an alternative to a near-field laryngectomy (NFL).

Background: The survival from traumatic laryngotracheal separation (LTS) is rare. For those who survive, the management of LTS has traditionally been primary repair and the insertion of a tracheostomy tube ± laryngeal stent. Long-term goals of treatment include patency of the airway, adequate voice production and deglutition without aspiration. Case: We report a case of complete laryngotracheal separation with bilateral vocal cord paralysis (BVCP) after a clothesline injury. Intraoperative decision was made to leave the patient intubated and delay the insertion of a tracheostomy tube. The patient was successfully decannulated two months post injury with adequate voice and swallow in the context of bilateral vocal cord immobility. Conclusion: This case highlights the potential value of prolonged intubation and delayed tracheostomy in patients with laryngotracheal trauma. Prolonged intubation may allow for healing at the primary repair site, act as a laryngeal, and additionally allow for paramedian fixation of the vocal cords. All of which may increase the chance of decannulation and improve long-term functional outcomes. Keywords: Laryngology, Laryngeal trauma, Vocal cord paralysis, Tracheostomy, Prolonged intubation

Laryngotracheal disruption in children is rare but life-threatening, and endolaryngeal injuries may go overlooked. We present the case of a 10-year-old boy who sustained near-complete laryngotracheal separation, multiple laryngeal fractures, and arytenoid and vocal fold avulsion following blunt cervical trauma. These injuries were not identified radiographically and only became apparent intraoperatively. Following surgical repair, the patient was successfully decannulated, eating a normal diet, and had a serviceable speaking voice within 2 months. In children, the diagnosis of severe endolaryngeal injuries may be elusive and therefore require high degree of clinical suspicion. Surgical success requires accurate diagnosis and prompt intervention.

Significant laryngeal injuries are rare and often fatal. Incidence is estimated to be one in 30,000 emergency room visits. A much smaller subset result in complete laryngotracheal separation, classically as a result of blunt force trauma [1]. To the author's knowledge, only two cases of such injury sustained by stabbing have been reported in the literature [2,3]. Here we present the third reported case. Keywords: Laryngotracheal, Separation, Complete, Knife, Esophagus

Chronic aspiration can be a life-threatening disorder of variable etiology. Often patients, both pediatric and adult, have suffered neurological devastation placing them at an increased risk of morbidity and mortality from laryngeal incompetence and the inability to protect their airways from soilage. Numerous surgical procedures have been described to tackle this problem; however, most definitive procedures cause damage to the intrinsic integrity of the larynx and are irreversible. Laryngotracheal separation with and without diversion is a definitive treatment option for intractable aspiration, that is, technically simple whereas still preserving the larynx for the possibility of future reversal. It is effective with a low complication profile. This article would address the indications, advantages, and surgical technique to laryngotracheal separation with or without diversion.

Less than one percent of trauma admission cases are categorized as pediatric neck trauma [13]. Nevertheless, due to an increasingly mobile society, there has been an increasing frequency of pediatric neck trauma with motor vehicle accidents being the most common mechanism of injury [8]. We present a case of laryngotracheal separation from a blunt, clothesline injury to the neck in a pediatric patient. We also review the literature and discuss the benefit of balloon airway dilation and its assistance in the management of laryngeal trauma and its resultant effects.

Purpose: Whether tracheoesophageal diversion (TED) is preferable to laryngotracheal separation (LTS) is unclear. This study examined the need for tracheoesophageal anastomosis by reviewing complications after TED and LTS and administering a questionnaire on postoperative quality of life. Patients and methods: Medical records of TED/LTS cases performed at a single institution from 2003 to 2015 were retrospectively reviewed and a questionnaire was administered to parents of patients at an outpatient visit. Results: A total of 40 TED and 18 LTS cases were included. Complications occurred in six TED cases and one LTS case, with no significant differences between groups ( P =0.42). A total of 22 parents of patients (TED 16 cases; LTS six cases) completed the questionnaire. Voice production was reported in three TED cases and two LTS cases. Patients indicated that suctions were ‘decreased’ in 13 and ‘unchanged’ in two TED cases, but ‘decreased’ in one and ‘unchanged’ in five LTS cases ( P =0.0055). Readmissions were ‘increased’ in one and ‘decreased’ in 14 TED cases, but ‘decreased’ in three and ‘unchanged’ in three LTS cases ( P =0.015). Conclusion: Postoperative complication rate was equivalent between groups, and the numbers of suctions and readmissions were decreased in the TED group. Therefore, tracheoesophageal anastomosis should be performed more commonly. Keywords: complication, laryngotracheal separation, quality of life questionnaire, tracheoesophageal diversion

There is a risk of developing a fatal trachea-innominate artery fistula following laryngotracheal separation for the prevention of intractable aspiration pneumonia. We developed a novel technique of surgical closure of the larynx to avoid this complication and provide long-term cannula-free care.

Objectives/Hypothesis We describe management of an infant with chronic aspiration as a result of severe and rarely described laryngeal dysgenesis. Results A neonate with severe maldevelopment of the laryngeal structures required tracheostomy for respiratory distress on day-of-life 1, but the patient continued to have aspiration pneumonias. After failing to improve with conservative measures, the infant underwent laryngotracheal separation (LTS), which was successful in preventing aspiration. The patient has had no further pneumonias. Conclusions The presented case illustrates that LTS may be considered a safe and effective initial treatment option for chronic aspiration in select infants with severe dysgenesis of the larynx. Laryngoscope, 124:2186–2189, 2014

Laryngotracheoesophageal cleft (LTEC) is an extremely rare congenital malformation that is difficult to treat. We present a female patient with type 4 LTEC associated with multiple significant malformations. She suffered from a severe asthma attack due to aspiration of saliva, and it was determined that she should undergo surgery for associated congenital heart disease as early as possible to ensure long-term survival. Therefore, we performed laryngotracheal separation with an end-tracheostomy to completely and immediately prevent aspiration. She was then able to undergo radical surgery for her congenital heart disease. She recovered well postoperatively, and long-term survival is expected.

Objectives:To validate the ovine model of profound oropharyngeal dysphagia and compare swallowing outcomes of laryngotracheal separation with those of total laryngectomy.Methods:Under real-time fluoroscopy, swallowing trials were conducted using the head and neck of two Dorper cross ewes and one human cadaver, secured in lateral fluoroscopic orientation. Barium trials were administered at baseline, pre- and post-laryngohyoid suspension, following laryngotracheal separation, and following laryngectomy in the ovine model.Results:Mean pre-intervention Penetration Aspiration Scale and National Institutes of Health Swallow Safety Scale scores were 8 ± 0 and 6 ± 0 respectively in sheep and human cadavers, with 100 per cent intra- and inter-species reproducibility. These scores improved to 1 ± 0 and 2 ± 0 post-laryngohyoid suspension (p < 0.01). Aerodigestive tract residue was 18.6 ± 2.4 ml at baseline, 15.4 ± 3.8 ml after laryngotracheal separation and 3.0 ± 0.7 ml after total laryngectomy (p < 0.001).Conclusion:The ovine model displayed perfect intra- and inter- species reliability for the Penetration Aspiration Scale and Swallow Safety Scale. Less aerodigestive tract residue after narrow-field laryngectomy suggests that swallowing outcomes after total laryngectomy are superior to those after laryngotracheal separation.

Objectives/Hypothesis: Recurrent pneumonia due to intractable aspiration is a life-threatening disease. A tracheal flap method for children without previous tracheostomy has been previously reported. This study reports that improvements of this method and its three subtypes are widely applicable to patients with various conditions. Study Design: Surgical technique study. Methods: The tracheal flap method does not involve transection of the trachea but achieves laryngotracheal separation using the tracheal, mucoperichondrial, and sternohyoid muscle, along with anterior cervical skin flaps. This method can be divided into three subtypes as follows: A-type, utilizing the tracheal flap (for patients without previous tracheostomy); B-type, utilizing the mucoperichondrial and sternohyoid muscle flaps (for patients lacking an anterior tracheal wall); and C-type, utilizing the esophageal flap (for patients with severe hypersalivation). In all three subtypes, the anterior cervical skin flap is employed. Results: The tracheal flap method was performed in 30 patients (24 children and six adults) at risk of developing intractable aspiration pneumonia. In all 30 cases, aspiration pneumonia was prevented without severe complications. No fistula formation was observed. Conclusions: All three subtypes (A-, B-, and C-type) of the tracheal flap method are effective in preventing the recurrence of aspiration pneumonia. This method is applicable to diverse patient backgrounds regardless of age or previous tracheostomy. It is less invasive than Lindeman procedure. Furthermore, this method is acceptable to patients' families and improves the QOL of both patients and caregivers. Laryngoscope, 2012

Laryngotracheal separation is often performed to prevent intractable aspiration for children with severe mental and physical disabilities. However, tracheo-innominate artery fistula after surgery can occur as a severe complication and cause fatal hemorrhage. We have therefore developed a novel procedure to prevent tracheo-innominate artery fistula. Surgery was performed by making an H-shaped incision and creating skin flaps. The trachea was not raised anteriorly and the skin flaps were sutured to the trachea. We performed this procedure on nine patients, and no major complications occurred in any case. This procedure can be expected to reduce the occurrence of tracheo-innominate artery fistula.

Objectives: In children with severe physical and mental disabilities who repeatedly develop aspiration pneumonia due to intractable aspiration, laryngotracheal separation/tracheoesophageal anastomosis or laryngotracheal separation has been performed in many institutions for the prevention of aspiration, and good results have been reported. However, families sometimes show a marked reluctance to give consent to these surgical techniques because of tracheal transection. A purpose of this study is to evaluate a new surgical procedure for laryngotracheal separation without tracheal transection. Study Design: Case-series study. Methods: As a new, simple, less invasive surgical technique for the prevention of aspiration without tracheal transection, we performed tracheal closure (tracheal flap method) in six children. A U-shaped flap of the tracheal anterior wall from the 2nd to the 4th/5th tracheal ring was produced, bent toward the tracheal lumen, and sutured to the tracheal posterior/lateral walls by mattress stitches for tracheal closure. In addition, the closure was covered with a cutaneous U-shaped flap for reinforcement and a permanent tracheal stoma was constructed. Results: In all six patients, aspiration pneumonia could be prevented without severe complications. Conclusions: Tracheal closure (tracheal flap method) has effects comparable to those of other surgical techniques for the prevention of aspiration, and may be useful for aspiration prevention in children with severe physical and mental disabilities.

脊髄小脳変性症患者の気管喉頭分離術の麻酔を経験した. 既往歴として声帯の外転障害による上気道の閉塞があり, 気道管理に配慮を要した. 喉頭展開時に観察された声門に異常は明らかでなかったが, 細径の気管チューブでなければ気管挿管は困難であった. 脊髄小脳変性症など多系統萎縮症では, 後輪状披裂筋の麻痺のため上気道の閉塞が起こることがある. 全身麻酔を行う場合には, 声門部の狭窄に注意し, 細径の気管チューブを準備するとともに, 経皮的気管穿刺や気管切開などの準備が必要である.

We report the outcome of laryngotracheal separation for the treatment of intractable aspiration in eight patients; six children and two adults. The surgical procedures should be adopted depending on whether the patient is a child or adult because of differences in the anatomical stiffness of the trachea. Postoperative pharyngeal-tracheal leakage in one case was treated conservatively for three months and the fistula was closed. As a result, recurrent aspiration subsided in all of the patients. In addition, in some cases of tracheal granulations caused by the canula, the granulations disappeared.

Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented.

Tracheoesophageal diversion (TED) and laryngotracheal separation (LTS) can prevent aspiration pneumonia and improve the morbidity of patients with severe motor and intellectual disability (SMID). By improving hospitalization rates and care needs, the quality-of-life can be improved for the patients and their parents.This study evaluated the clinical outcomes of TED and LTS in patients with intractable aspiration and SMID.This study retrospectively reviewed patients with SMID and intractable aspiration pneumonia who underwent TED or LTS at the institution between January 2008 and January 2015. It assessed the frequency of sputum suctioning, the number of pre-operative and post-operative hospitalizations, the operative time, and complications.Forty patients were identified during the study period. After surgery, there were significant reductions in the frequency of secretion suctioning (from 165.0 times/day to 33.0 times/day) and the number of hospitalizations because of aspiration pneumonia (from 5.4 times/year to 0.2 times/year). A tracheocutaneous fistula occurred in one (2.5%) patient, and two (5.4%) patients developed tracheoinnominate artery fistulas. In the latter group, the innominate arteries were successfully ligated and endovascular embolization was performed.

Laryngotracheal separation is a rare variant of laryngeal trauma. However it is life threatening and potentially fatal. Patients with this injury usually succumb at the site of the accident itself. Here we present two cases of laryngotracheal separation of different etiology and of different outcomes. The treatment advocated for laryngotracheal separation is initially airway stabilization followed by formal repair of the transected trachea. However both our cases illustrates that the outcomes can be different and that a long term treatment plan should be individualized to each patient.

Objectives: Laryngeal dysfunction leading to incompetence and intractable aspiration can be a life-threatening problem. Laryngotracheal separation (LTS) can be used to prevent aspiration, but results in aphonia. The options for alaryngeal speech following LTS are limited. Methods: We performed tracheoesophageal puncture (TEP) and insertion of a Blom-Singer valve in 3 patients in an attempt to restore their voice after LTS for chronic aspiration. Results: Two patients had intractable aspiration (5 and 14 years) after full-course radiotherapy for laryngeal cancer, and 1 patient had aspiration after a stroke. In the first patient TEP was done as a secondary procedure, and in the other 2 patients it was done at the time of the LTS. The TEP was successful in providing these patients with phonation ability after their LTS procedure. There was no morbidity from these procedures. Conclusions: Creation of a TEP after an LTS procedure is relatively simple and relatively safe, and allows for the control of aspiration while maintaining vocal function.

Chronic aspiration is a difficult and potentially lethal problem. Patients who have persistent soilage of the upper respiratory tract despite discontinuing oral intake may be offered surgical intervention to avoid life-threatening pulmonary infections. The Lindeman procedures (tracheoesophageal diversion and laryngotracheal separation) have gained popularity as surgical treatments for intractable aspiration because of their efficacy in preventing aspiration and their technical simplicity. A major downside of these procedures is the necessity for a tracheostoma and the loss of speech following surgery. Rarely, patients recover from the neurologic deficits which led to their intractable aspiration and desire reversal of their Lindeman procedure. While few "successful" reversals have been reported, detailed accounts of the long-term results of such patients are lacking. We describe a patient who underwent a laryngotracheal separation for intractable aspiration following a brainstem stroke. In the following six months he experienced significant neurologic recovery and, after careful evaluation, underwent surgical restoration of laryngotracheal continuity. Five years later he speaks fluently and has no dietary restrictions. Videofluooroscopic examination and quantitative voice analysis reveal near-normal laryngeal function.

Laryngotracheal separation (LTS) is a surgical procedure for the treatment of intractable aspiration which separates the upper respiratory tract from the digestive tract.We performed LTS in three pediatric patients with severe central nervous disorders, resulting in decreased hospitalization and nursing requirements. Considering the reliability and simplicity of the procedure, we prefer LTS to tracheoesophageal diversion, especially for pediatric patients. Pooling in the subglottic laryngotracheal blind pouch created in LTS has been thought to be a potential source of a tracheocutaneous fistula, however, practically, tracheocutaneous fistula is uncommon because changing of posture and swallowing clear the pooling in the blind pouch.In pediatric patients, we consider the indication for LTS as follows: a patient with intractable aspiration, whose original disease is difficult to cure, and whose vocal dysfunction will be irreversible in the future.

Summary Closed injuries with complete separation larynx and tracheae are very rare. They are connected with high risk of death in the place of an accident. It is connected with acute respiratory obstruction due to local edema and presence of blood in the lumen of airway. We present the case of a complete laryngotracheal separation, 47-years-old male, as a result of a car accident. It has been surgically treated with good functional effect.

Objectives:(1) Recognize the often subtle clinical presentation of complete laryngotracheal separation. (2) Address immediate course of action in the event of a total separation. (3) Describe components of a successful surgical repair.Methods:Over 3 years at a tertiary care center in Las Vegas, Nevada, 3 cases of complete laryngotracheal separation secondary to blunt trauma were successfully treated with prompt surgical intervention. Various surgical techniques were employed, given the complexity and different characteristics of each patient’s presentation, with cartilaginous reduction and fixation favored over soft tissue apposition, along with fenestration tracheostomy procedures to prevent infection of the repair sites. Successful long-term outcome was defined by tracheostomy tube decannulation and lack of multiple tracheal dilations or other tracheoplasty procedures to maintain a patent airway.Results:All 3 patients initially required a tracheostomy due to airway edema, but each made an uneventful rec...

Objectives: To confirm that laryngotracheal separation (LTS) is a satisfactory treatment for patients with intractable aspiration pneumonia, even though it does not require tracheoesophageal anastomosis. Study Design: Retrospective. Methods: Nine patients with intractable aspiration pneumonia underwent LTS at our institution from 1996 to 1999. Two patients underwent postoperative barium swallow radiography. Results: Neither halitosis nor stimulation of the cough reflex occurred due to pooled secretions in the blind pouch of the proximal tracheal segment. Barium swallow radiography confirmed that the secretions drained within 40 min by swallowing or a change in patient position. Conclusion: LTS is a satisfactory solution to the problem of chronic aspiration. Neither pooled secretions in the proximal tracheal segment nor fistula formation were significant postoperative problems.

Resumen: Presentamos el caso de una paciente con bronco-aspiración crónica grave debida a un tumor en el tronco encefálico y las secuelas de su tratamiento. La parálisis bilateral de pares craneales bajos y el reflujo gastroesofágico intenso provocaron infecciones respiratorias por aspiración e ingreso continuado durante año y medio, a pesar del tratamiento médico y la traqueotomía e inserción de una cánula con balón. La separación laringotraqueal redujo drásticamente las infecciones y mejoró la calidad de vida. Abstract: We present the case of a patient with brain stem tumour and severe chronic aspiration. The bilateral dysfunction of lower cranial nerves and the severe gastroesophageal reflux contributed to the aspirations. Despite medical treatment and cuffed tracheotomy tube, she required almost constant hospitalization for a year and a half due to respiratory infections. Laryngotracheal separation dramatically reduced the infections and improved her quality of life.

We performed laryngotracheal separation in four patients with intractable aspiration. All four patients could eat post orally and did not suffer from postoperative aspiration pneumonia. There are other surgical procedures for intractable aspiration which do not preserve vocal function, such as tracheoesophageal diversion (Lindeman, 1975), laryngeal closure and total laryngectomy. We considered this procedure to be simpler, more effective and generally more acceptable. Neither bad breath nor laryngeal reflex resulted. This procedure can theoretically restore the larynx after surgery if the patient's aspiration improves, but practically we never have experienced the case.

Objectives: Laryngotracheal separation (LTS) is an ideal surgical method for intractable aspiration; however, the oral side of the tracheal stump can easily disintegrate. Therefore, we developed a modified LTS method. We performed subglottic laryngeal closure (SGLC) as a new surgical method and evaluated the outcomes. Methods: We retrospectively analyzed the medical records of 36 patients (28 male and 8 female; 15 to 91 years of age) who underwent SGLC between 2007 and 2011 at Tottori University Hospital, Japan. Operative data (operative time, intraoperative bleeding, and time to drain removal), outcomes (aspiration and changes in nutritional status), and complications with regard to the surgical method were examined. The occurrence of a subcutaneous proximal laryngeal stump fistula was evaluated by videofluoroscopy. Results: The SGLC was performed safely in all patients. Fistulization was observed in only 1 of the patients (2.8%), and major bleeding after surgery was observed in 1 patient (2.8%). The procedure relieved aspiration pneumonia in all patients. Conclusions: We conclude that SGLC is effective for treating and preventing pulmonary aspiration. The incidence of postoperative complications, particularly that of subcutaneous fistulas, was very low. Therefore, this method may be useful for patients in poor condition.

Chronic aspiration in the neurologically impaired child is associated with significant medical and social complications. Traditional surgical management has often relied on tracheotomy. This may well fail to control aspiration. The purpose of this retrospective study was to determine which neurologically impaired children would benefit from a laryngotracheal separation (LTS), as opposed to tracheotomy, as the primary surgical procedure to control chronic salivary aspiration. Patient selection was based on neurologic status, verbal communication ability, likelihood of neurologic recovery, and failure of previous treatments to control aspiration. Nineteen neurologically impaired children aged 8–172 months with chronic salivary aspiration underwent LTS. A total of 73.6% of these patients had prior tracheotomies, yet they continued to aspirate. Two early and three late complications were noted. No instances of fistula formation were noted. There were no deaths related to complications of the surgery or persistent aspiration. Follow-up 1–62 months after surgery demonstrated that complete control of the aspiration was achieved in all of these children. Two of the children who had achieved verbal communication prior to the procedure lost this ability. Improved general health and ability to resume oral intake was noted in all patients. This, combined with a decrease in the need of frequent suctioning, was felt by the families of these children to be a major improvement in the quality of life. Laryngotracheal separation appears to be a simple and effective means of controlling chronic aspiration. It should be considered as a primary treatment of aspiration in the properly selected child with neurologic disease.