This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: ENT
[{'content': 'Gold standard surgical procedure for prevention of aspiration is - \nSelect and explain. \nA. Thyroplasty, B. Tracheostomy, C. Tracheal division and permanent tracheostomy, D. Feeding gastrostomy jejunostomy', 'role': 'user'}, {'content': 'Answer: C \nExplanation: Aspiration is the passage of foreign material beyond the vocal cords:\n\nThe larynx has 3 distinct functions – respiration, phonation and airway protection. Dysfunction of larynx can lead to aspiration.\nThe primary goal of treatment of aspiration is to separate the upper digestive tract from the upper respiratory tract for a short\xa0period of time or in some cases, permanently.\nThere are 3 broad categories of treatment.\n\nTemporary/Adjunct Treatments\n\nMedical Therapy – in the form of antibiotics is important to prevent aspiration pneumonia.\nIt is important to make the patient NPO, to avoid further aspiration and to find an alternate feeding route to maintain the patients\xa0nutritional status. A nasogastric tube (feeding gastostomy/jejunostomy) is commonly placed, but this may actually increase the\xa0aspiration reflux by making the lower esophageal and upper esophageal sphincters incompetent.\n\nBut Still\n“Tubal feeding (either by nasogastric tube or gastrostomy) however is often unavoidable.” – Scotts Brown 7/e, vol 1 p 1278\n\nHere it is important to note that feeding Gastrostotomy / jejunostomy are not the gold standard methods of preventing aspiration\xa0but rather are done to maintain the nutritional status of patient and prevent further aspiration. In fact according to most texts\n\n– they are a common cause of aspiration.\n\nVocal cord medialization (by injecting Gel foam) is useful in unilateral paralysis.This is helpful but is rarely curative, if there is a\xa0serious aspiration problem.\nTracheostomy will often make aspiration worse by preventing laryngeal elevation on swallowing. It does however, allow easy\xa0access to the chest for suctioning. Even a cuffed tube doesn’t prevent aspiration as secretions pool above the cuff and the seal\xa0is never perfect”\xa0\n\nScotts Brown 7/e, vol 1 p 1278\nDefinite – Reversible Procedures\n\nEndolaryngeal stents: They function like a cork in the bottle. There job is to seal the glottis and therefore thay need to be used\xa0in conjunction with a tracheostomy tube. But they are not often used as they are effective only as a short term solution, plus\xa0there is risk of glottic stenosis.\nLaryngotracheal separation: The procedure involves transecting the cervical trachea and bringing out the lower end as a\xa0permanent end stoma\nAccording to Scotts Brown and Internet sites: It is the procedure of choice as it is reversible. But it has disadvantage of sacrificing voice.\nAlternative procedure is Tracheoesophageal diversion but has higher complication rates.', 'role': 'assistant'}]