Dysphagia following anterior cervical fusion.The anterior approach to the cervical vertebrae can cause dysphagia via many mechanisms. These mechanisms include recurrent and/or superior laryngeal nerve superior laryngeal nerve n. A branch of the vagus nerve at the inferior ganglion. At the thyroid cartilage, it divides into two branches, the internal, which supplies the mucous membrane of the larynx above the vocal cords; and the external, which injury, pharyngeal plexus injury, scarring of the pharynx itself, and the physical impeding of bolus transfer secondary to the presence of "hardware." The postoperative incidence of dysphagia following an anterior-approach cervical spine fusion cervical spine fusion Orthopedics The operative fusing of 2 or more cervical vertebrae due to trauma to the spine and/or bone degeneration has been reported to be 50.2% at 1 month, 32.2% at 2 months, 17.8% at 6 months, and 12.5% at 12 months. (1) We evaluated a 44-year-old woman who had undergone a C4-C5 fusion 4 years earlier and revision surgery 2 1/2 years after the original surgery. Her complaints included a weak voice and swallowing difficulties with "choking" episodes. Transnasal endoscopic evaluation detected a left arytenoid arytenoid /ar·y·te·noid/ (ar?i-te´noid) shaped like a jug or pitcher, as arytenoid cartilage. ar·y·te·noid n. 1. granuloma granuloma /gran·u·lo·ma/ (gran?u-lo´mah) pl. granulomas, granulo´mata an imprecise term for (1) any small nodular delimited aggregation of mononuclear inflammatory cells, or (2) such a collection of modified macrophages and a marked protrusion protrusion /pro·tru·sion/ (-troo´zhun) 1. extension beyond the usual limits, or above a plane surface. 2. the state of being thrust forward or laterally, as in masticatory movements of the mandible. in the posteriorpharyngeal wall (figure, A). Fiberoptic endoscopic evaluation of swallowing (FEES) revealed the presence of a moderate amount of postswallow residue superior to the protrusion, with all consistencies (figure, B). FEES also detected severe vallecular residue on solids after the swallow and trace aspiration of thin liquids. The source of the protrusion, which was believed to be the primary contributor to the patient's dysphagia, was the spinal fusion plate. [FIGURE A OMITTED] We have observed this type of mechanical obstruction to swallowing in several patients who had undergone anterior cervical fusion and who had been referred to our clinic by various institutions. In this patient, antireflux therapy and voice therapy were initiated to treat the granuloma. Dysphagia rehabilitation, including strengthening exercises to improve the patient's ability to achieve epiglottic epiglottic pertaining to or emanating from the epiglottis. epiglottic cartilage attached to the thyroid cartilage of the larynx by the thyroepiglottic ligament; it is the structural basis of the epiglottis. retroversion retroversion /ret·ro·ver·sion/ (-ver´zhun) the tipping backward of an entire organ or part. ret·ro·ver·sion n. 1. A turning or tilting backward, as of the uterus. 2. and pharyngeal bolus propulsion, led to a decrease in the amount of residue after swallowing, eliminated the aspiration, and improved the patient's quality of life. Reference (1.) Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: A prospective study. Spine 2002;27:2453-8. Susan G. Butler, PhD, CCC-SLP; Gregory N. Postma, MD; Stacey L. Halum, MD |
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