Total laryngectomy in patients with advanced bulbar symptoms of amyotrophic lateral sclerosis

Our objectives were to 1) increase awareness of total laryngectomy (TL) as a treatment for complications of bulbar weakness in patients with amyotrophic lateral sclerosis (ALS) and outline specific surgical indications; 2) educate physicians about the surgical procedure, peri-operative course and benefits from having a TL; and 3) retrospectively review the clinical course of Mayo Clinic-Florida patients with ALS who had a TL. The method used was a retrospective review of patients recommended to undergo TL for advanced bulbar symptoms related to ALS at the Mayo Clinic in Jacksonville, Florida. Between January 1999 and September 2008, 15 patients with severe bulbar symptoms associated with ALS were recommended to undergo TL. Only five patients opted for the surgery. All patients were aphonic at time of surgery with a multitude of bulbar symptoms. Average surgical time was 114 min (range 87-162 min). No intraoperative complications were reported. All patients and caregivers were pleased with the results of the TL. In conclusion, TL is a relatively safe, quick and uncomplicated surgical procedure that should be considered earlier and more frequently in the treatment plan of patients with advanced bulbar symptoms due to ALS. We recommend considering TL in patients with aspiration problems who are unable to phonate intelligibly.