Treatment of intractable aspiration - combined open medialisation thyroplasty with intra-glandular botulinum toxin injection.

[OBJECTIVE] This paper aims to introduce our combined approach, which provides definitive treatment for intractable aspiration while preserving phonation and highlights the importance of performing both procedures together.

[METHODS] We describe a case of intractable aspiration requiring a nasogastric tube and a tracheostomy tube. We propose a combined technique consisting of an open medialisation thyroplasty with intra-operative, intra-glandular botulinum toxin injection. The thyroplasty procedure medialises the left vocal fold to overcome glottic insufficiency. Botulinum toxin injection reduces salivary flow and prevents excessive pooling.

[RESULTS] The patient was followed up for twelve months. Video fluoroscopy demonstrated no evidence of aspiration. The patient was allowed a regular oral diet and decannulated two months post-operatively.

[CONCLUSION] This paper demonstrates the feasibility of our combined approach as a viable treatment option for intractable aspiration, particularly in patients with a strong desire for vocalisation. The cases must be selected carefully to ensure a favourable outcome.