Clinical Results of Surgical Closure of the Larynx with Removal of the Thyroid and Cricoid Cartilage for Intractable Aspiration Pneumonia in a Patient with Severe Motor and Intellectual Disability

Background : The indication of Kano’s glottic closure procedure for infants remains unclear, and it is unknown whether it is a better procedure in terms of complications and postoperative length of stay compared with existing operations for the prevention of aspiration. We therefore conducted a retrospective study to assess Kano’s glottic closure procedure, and discussed the findings.Methods : Five patients (aged between 1.5 and 25 years) with severe motor and intellectual disabilities underwent surgical closure of the larynx with removal of the thyroid and cricoid cartilage. We investigated the background factors, operative durations, complications of surgery, length of hospital stays after surgery, and outcomes in five patients.Results : The median height and weight of patients was 123cm and 18.6kg. Primary diseases ranged from birth injury to congenital disorder of unknown etiology. In 3 patients, tracheostomies and glottic closure were performed simultaneously. Two patients initially had tracheotomies. The median operative duration was 233 minutes. There were no postoperative complications; nevertheless, the length of the hospital stays after surgery was extended by three times compared to the time period of postoperative management. After being discharged from the hospital, four patients received home care, and three patients were free of tracheal cannula.Conclusion : The advantages of Kano's glottic closure procedure for infants were a short period of postoperative management due to no postoperative complications and being free from a tracheal cannula.