Otolaryngologic manifestations of amyotrophic lateral sclerosis.

Otolaryngological manifestations were examined in a series of 250 patients diagnosed as having ALS between 1976 and 1986. Surgical intervention was only required in 10 cases due to excessive drooling and aspiration. Five patients had submandibular gland excisions with only limited improvement in respect to drooling. One case having a unilateral tympanic neurectomy had significantly better drooling control. Cricopharyngeal myotomy is helpful when dysphagia is predominantly due to cricopharyngeal spasm. In our series, tympanic neurectomy and chorda tympanectomy provide the better control of drooling for these patients and has the added advantage of being performed under local anesthesia.

Pediatric tracheotomy.

The indications and complications of tracheotomy in 93 children between 1970-82 were studied and recorded. There has clearly been a shift in indications for pediatric tracheotomy while the early postoperative complication rate has improved. Longterm tracheotomy is on the increase due to a larger number of children with neurological problems and of infants requiring tracheotomy for chronic obstructive airway disease.

Duodenal "diverticulization" for massive haemorrhage from pancreatic pseudocyst.

A case of massive haemorrhage into the gastrointestinal tract from a pancreatic pseudocyst is presented. The pseudocyst was a complication of acute pancreatitis, and control of the haemorrhage by operation was difficult because of the friability of the cyst wall. The surgical procedure called duodenal diverticulization is described and was found to be a useful adjunct to suture ligation for bleeding which was almost uncontrollable and when death of the patient seemed inevitable.