Post-operative swallowing in multiple system atrophy

Area of Science:

• Neurology
• Otolaryngology
• Gastroenterology

Background:

• Multiple system atrophy (MSA) patients often require surgical interventions like tracheostomy (TR) and aspiration prevention.
• Limited research exists on the postoperative outcomes for MSA patients undergoing these procedures.
• Effective management strategies for dysphagia and respiratory issues in MSA are needed.

Purpose of the Study:

• To evaluate the efficacy of tracheostomy (TR) versus laryngeal closure (LC) in managing dysphagia and respiratory disorders in multiple system atrophy (MSA) patients.
• To determine the optimal surgical approach for improving swallowing function and oral intake in MSA.

Main Methods:

• Retrospective analysis of 18 MSA patients (2001-2014) who underwent tracheostomy (n=11) or laryngeal closure (n=12).
• Assessment of vocal fold impairment, dysphagia severity (using Penetration Aspiration Scale - PAS), and oral intake.
• Comparison of postoperative outcomes, including swallowing function and survival time, between TR and LC groups.

Main Results:

• Tracheostomy (TR) did not improve swallowing function (PAS scores) in any patient and worsened it in seven out of eleven.
• Laryngeal closure (LC) enabled all patients to regain partial or complete oral intake post-surgery.
• No significant difference in postoperative survival time was observed between the TR and LC groups.

Conclusions:

• Laryngeal closure (LC) is a favorable surgical option for managing severe dysphagia in multiple system atrophy (MSA) patients.
• LC demonstrates superior outcomes in restoring oral intake compared to tracheostomy (TR) in this patient population.
• Surgical intervention choice should prioritize functional swallowing and oral feeding in MSA management.