MARC REMACLE, MD, PHD
YVOIR, BELGIUM

The principle of inverted epiglottoplasty, compared with plication and suture of the free end of the epiglottis to the posterior commissure, is the suppression of the natural epiglottic spring motion. The pharyngoepiglottic folds are preserved in order to function as the rotational axis for the freed epiglottis. The petiole of the epiglottis is anchored to the posterior commissure; the free end of the epiglottis is sutured above the thyroid cartilage ala and angle; and the lateral sides of the suprahyoid epiglottis are sutured to the superior part of the arytenoids. This procedure was successful in 7 of 8 patients with intractable aspiration. One patient, who had previously undergone radiotherapy, presented postoperatively with complete epiglottic necrosis that required total laryngectomy. The procedure can be reversed. The procedure fits within the management strategy addressing aspiration.