S141 – Total Laryngectomy in Patients with Advanced Bulbar ALS

Abstract

Objectives 1) Identify patients with Amyotrophic Lateral Sclerosis (ALS) who would benefit from a total laryngectomy (TL) and outline specific surgical indications. 2) Educate physicians about the surgical procedure, perioperative course, and benefits from having a TL. 3) Review the clinical course and results of patients with ALS who had a TL. Methods From January 1999 to January 2008, charts from the Mayo Clinic in Jacksonville, FL, were retrospectively reviewed. 3 patients who underwent TL for advanced bulbar symptoms related to ALS were identified and their clinical course reviewed. Results At the time of surgery, all patients were aphonic with a multitude of symptoms including: dysphagia, drooling, respiratory insufficiency, aspiration pneumonia, choking and coughing. Average surgical time was 103 minutes. No intraoperative complications occurred. 2 patients with pre-existing respiratory insufficiency experienced postoperative pulmonary complications, resulting in a prolonged hospital course, median stay 17 days (range 6–29 days). One patient was lost to follow-up postoperatively. The other 2 and their caregivers were pleased with the results of TL. Benefits reported were: elimination of choking spells, improved comfort with mechanical ventilation, safe and easy tracheostomy tube changing and cleaning, less traumatic tracheobronchial suctioning, increased oral intake, reduced anxiety of aspiration, and less coughing. Conclusions TL is a relatively safe, quick, and uncomplicated surgery that should be considered earlier and more frequently in the treatment plan of patients with advanced bulbar symptoms of ALS. Patients with preoperative respiratory insufficiency may experience prolonged recovery times.