[Dysphagia in amyotrophic lateral sclerosis--the mechanism and managements]

Amyotrophic lateral sclerosis (ALS) raises progressive dysphagia that causes aspiration. This diseases affects oral phase first and then pharyngeal phase of swallowing. Aspiration pneumonia by dysphagia becomes major problem from clinical aspect to cause aggravation of vital prognosis. We explain the mechanism of dysphagia from deglutition dynamics and discuss the clinical managements. Several functional operations such as cricopharyngeal myotomy, laryngeal suspension and so forth, have been applied to prevent aspiration, with satisfactory results in cases with mild dysphagia. However, in cases of ALS patients with severe aspiration, the results are poor. Then we have to divide airway from digestive tract completely to prevent aspiration by laryngectomy. However, the larynx is a multi-functional organ, loss of the larynx does improve the swallowing but loose phonatory function. We need to evaluate a deglutition function before starting of treatments of dysphagia. Besides, we also need to put hopes and life style of patients in consideration. We have to be very careful to choose the way of surgical treatment and the time of operation. We can conclude that laryngectomy is useful for vital prognosis and amelioration of QOL in ALS patients.