Bulbar Palsy (Supranuclear Or Lower Motor Neuron).

Bulbar Palsy (Supranuclear Or Lower Motor Neuron).

This causes dysphagia

Child sucks liquids poorly

Chews and swallows solid food with difficulty.

In supra-nuclear bulbar palsy,

            Jaw jerk is exaggerated

            Signs of generalized spastic cerebral palsy

Lower motor neuron disease with flaccid bulbar palsy and facial diplegia constitutes the Möbius syndrome.

� W l g � �� ologic workup.

Complications

Hematoma, osteomyelitis, or bone spur formation (if biopsy is performed).

Procedure

Identify site for aspiration. For most children the posterior iliac crest is preferred, although the anterior iliac crest may be used. For some children younger than 3 months of age the tibia can be used.

Position patient in the prone position with a pillow elevating the pelvis (for posterior iliac crest).

Prepare the site in sterile fashion and anesthetize the skin, soft tissue, and periosteum with 1% lidocaine.

Insert needle (16-or 18-gauge) with steady pressure in a boring motion

Needle should be directed perpendicular to the surface of the bone

Enter the ilium at the posterior superior iliac spine, which is a visible and palpable bony prominence superior and lateral to the intergluteal cleft.

Needle will enter cortex and “pop” into the marrow space; the needle should be firmly anchored in bone.

Remove stylet, and aspirate marrow with a 20-mL or larger syringe. Apply pressure after procedure.

NOTE: In young infants and those with infiltrated leukemia, marrow aspiration may be difficult

bone marrow biopsy thus may be necessary.