This Keynote lecture would be delivered by Professor Bhik Kotecha who has three decades of experience in management of OSA and will outline the progress made from the era of Charles Dickens to the present period.

Swallowing disorders can be caused by a variety of etiologic factors, and the pathophysiology and findings of dysphagia in each patient are different. Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Surgical procedures for patients with severe dysphagia can be categorized into three types according to their purpose: tracheostomy to create a route for suctioning aspirated material and secretions from the lower respiratory tract through the trachea; swallowing function improvement surgeries to improve pharyngeal swallowing while preserving speech function; and aspiration prevention surgeries to prevent aspiration despite loss of speech function.

In Japan, aspiration prevention surgeries for patients with severe dysphagia have been practiced for more than three decades. Beyond total laryngectomy and laryngotracheal separation, various techniques have been developed. There are several types of aspiration prevention surgeries, such as removal of the larynx, altering the structure of the trachea, and closure of the larynx. Some of these procedures can be performed under local anesthesia, and certain methods have the potential to facilitate postoperative oral intake. However, worldwide recognition of aspiration prevention surgery is still limited.

In my practice, I determine the surgical approach based on a multifaceted assessment, including the patient’s primary diagnosis, systemic condition, anatomical features, and swallowing function. Voice loss and reduced olfactory function are common concerns following aspiration prevention surgery. In addition to postoperative swallowing rehabilitation, I also provide patients with guidance on alternative voice training and olfactory rehabilitation. This lecture will focus on patient-tailored aspiration prevention surgeries designed to enhance patients’ quality of life, drawing on my extensive surgical experience.

this is a great debate on surgical approaches to Zenker’s diverticulum