שאלה משלב א׳ בא.א.ג וכירורגיה של ראש וצוואר · מועד 2023, שאלה 79

FOUR-DUCT LIGATION - ligation of both submandibular and both parotid ducts - is the intervention with evidence for reducing chronic aspiration of saliva, markedly lowering pneumonia rates and often allowing decannulation, with the bilateral submandibular gland excision plus parotid duct ligation as an alternative. Bilateral injection medialisation treats glottic insufficiency rather than salivary aspiration, tube feeding does not stop aspiration of saliva (and has not been shown to prevent pneumonia), and tracheostomy itself worsens aspiration by impairing the cough and glottic closure.