Palliative surgery in patients with bulbar amyotrophic lateral sclerosis.
Patients with amyotrophic lateral sclerosis (ALS), a progressive neurodegenerative disorder, commonly develop bulbar symptoms including dysphagia, dysarthria, and defective airway protection. Otolaryngologists/head and neck surgeons are frequently asked to assist in the management of these problems. We reviewed our experience of 13 surgical procedures in 7 patients with advanced bulbar ALS. In spite of technically good surgery, 3 patients died within 1 week of hospitalization. Four patients appeared to benefit from the surgery. Patients with bulbar ALS are a high risk group because of chronic malnutrition and dehydration, covert aspiration and pneumonitis, and diminished ventilation. A team approach to these problems is stressed. Perioperative morbidity can be reduced with careful preoperative preparation and patient selection.
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Department of Otolaryngology/Head & Neck Surgery, University of Washington, Seattle.
Hillel
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D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology; D004946:Esophagostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D014140:Tracheotomy