Clinical Study of Postoperative Swallowing in Multiple System Atrophy

Abstract

Objectives:

Some patients with multiple system atrophy (MSA) require surgical management such as tracheostomy and laryngeal closure with the evolution of diseases such as severe dysphagia and/or respiratory disorder. There are few reports about the relationship between dysphagia and vocal cord paralysis (VCP) and about postoperative feeding in MSA patients. The aim of this study is to describe clinical management and outcomes of surgical treatment in MSA patients.

Methods:

From 2001 to 2013, 16 MSA patients (11 males) underwent surgical procedures. All cases were retrospectively evaluated for vocal fold fixed position, degree of dysphagia, the duration between the onset of dysphagia (or dyspnea) and surgery, and perioperative feeding.

Results:

The mean age was 64.3 years (range, 52-76 years). Tracheostomy was made in 9 patients, and laryngeal closure was performed in 11 patients. Four of 7 patients underwent laryngeal closure (LC) 7.5 weeks (2 to 14) after tracheostomy. Eleven patients had severe dysphagia. The bilateral vocal folds were fixed in a median position in 13 patients. The duration from onset of MSA and surgery was 3 to 111 months (median 59 months). All patients with LC were preoperatively unable to take anything from mouth, but postoperatively all of them regained complete/partial oral intake.

Conclusions:

In MSA patients, a correlation between dysphagia and VCP is suggested, however it was revealed that dysphagia does not always precede VCP. This study also showed that LC enables patients to take food orally, regardless of severe dysphagia.