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A New Technique in the Management of Long-term Swallowing Disorders

Harvey M. Tucker, MD; Michael Broniatowski, MD; Stephen Chase, MD

Arch Otolaryngol. 1985;111(3):187-189.

Abstract
• Surgeons whose patients require long-term management of nutritional intake must usually choose from among nasogastric tube feedings, hyperalimentation by intravenous route, and/or gastrostomy. Cervical esophagostomy has been a useful but not widely employed alternative. The advantages of cervical esophagostomy over other modalities include the avoidance of laparotomy, absence of a nasogastric tube, and lack of the complications of a long-term indwelling intravenous catheter. The disadvantages of standard esophagostomy include the need to wear a tube to keep the fistula open, leakage, and skin irritation. Dobie et al presented a skin flap esophagostomy technique in 1978. We report a variation of this concept that has resulted in no salivary leakage and that allows the patient to dispense a tube between feedings. It provides a directional stoma in which the internal orifice is considerably inferior to the external one, resulting in continence and thus preventing substantial leakage.

(Arch Otolaryngol 1985;111:187-189)

Author Affiliations
From the Cleveland Clinic Foundation.

Footnotes
Accepted for publication June 5, 1984.

Read before the American Academy of Facial Plastic and Reconstructive Surgery, Palm Beach, Fla, May 8, 1984.

Reprint requests to Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44106 (Dr Tucker).

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