(LABIOGLOSSOLARYNGEAL PARALYSIS)
A progressive atrophy and paralysis, invading the lips, tongue, pharynx
and larynx, due to involvement (sclerosis) of the motor nuclei of the
medulla oblongata that supply these tissues. It is rarely primary,
more =frequently secondary= to tabes, amyotrophic lateral sclerosis
and diseases involving the motor nuclei of the medulla. Diphtheria,
syphilis and lead poisoning are said to predispose. =Osteopathic
lesions= of the upper cervical are also important factors in many
cases. Halbert says: “The nuclei of the hypoglossal, the spinal
accessory, the facial and the motor part of the trifacial nerves suffer
most decidedly from the sclerotic degeneration. The nerve trunks and
the muscles which they supply gradually show the effects of a similar
degeneration.”
The =acute form= results from hemorrhage, embolism or inflammatory
softening. The onset is usually sudden. The speech is difficult or
entirely lost. There are dribbling of saliva, difficult swallowing,
flabbiness and flaccidity of the lips and frequent choking spells
occur. These cases may prove rapidly fatal.
The =chronic form= may result from progressive muscular atrophy,
insular sclerosis, amyotrophic lateral sclerosis, acute ascending
paralysis or chronic poliomyelitis. The paralysis starts in the tongue,
the first symptom being a slight defect in the speech. When the lips
become involved, the patient cannot whistle and speech is rendered
still more difficult. The lips are prominent and the lower one drops.
The saliva is increased in amount and there is drooling. Mastication
of the food becomes difficult. The tongue becomes atrophied and the
mucous membrane wrinkled. Fibrillary tremors of the lips and tongue are
present. Sensory symptoms are not present. Taste is normal. Paralysis
of the larynx is not so pronounced as of the other parts.
=Diagnosis.=—This is generally easy as the symptoms are well marked.
The =prognosis= is unfavorable.
=Treatment.=—Little can be done in the majority of cases. Only in those
cases where the paralysis is caused by =cervical lesions= can much hope
be given. Derangements of the cervical vertebræ, especially the atlas
and axis, occasionally influence the circulation in the medulla to such
an extent that the motor nuclei are greatly involved. The subluxated
vertebras may interfere with the blood-vessels directly or through
the vasomotor and trophic nerves. When the onset is not abrupt, the
prognosis is more favorable. When deglutition is impaired, the stomach
tube should be used in feeding the patient to prevent the food passing
into the trachea.