Department of Otolaryngology--Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Otolaryngol Head Neck Surg. 2012 Mar;146(3):419-25. doi: 10.1177/0194599811429259. Epub 2011 Nov 18.
To describe swallowing disorders encountered after cerebellopontine angle surgery and to explore variables associated with increased incidence of postoperative dysphagia.
Case series with chart review.
Single academic medical institution.
Chart review of 181 consecutive patients undergoing surgical excision of cerebellopontine angle pathology from January 2008 to December 2010 at the Johns Hopkins Hospital. Presence and characteristics of dysphagia were determined by review of speech pathologist reports. Other clinical variables were extracted from the electronic medical record, and statistical analyses were applied to determine factors associated with postoperative dysphagia.
Immediate postoperative dysphagia was identified in 57 of 181 patients (31%). Oral, oropharyngeal, and pharyngeal deficits accounted for 51%, 37%, and 12% of dysphagic symptoms, respectively. Facial nerve weakness in the immediate postoperative period was noted in 91% of dysphagic subjects compared with 43% of those without. Mean House-Brackmann score for dysphagic individuals was 4 compared with 2 in the nondysphagic group. Diet alterations were required for 65% of dysphagic individuals, and an additional 9% required tube feeding. Common findings during videofluoroscopic swallowing studies were pharyngeal residue, reduced pharyngeal constriction, and anterior bolus loss. Abnormal penetration-aspiration scores (≥3) were found in 59% of those undergoing videofluoroscopic swallow studies.
Oral and pharyngeal swallowing deficits are commonly encountered after cerebellopontine angle surgery. Consultation with the speech-language pathologist appears most critical for any individuals demonstrating postoperative cranial nerve dysfunction, particularly for those with evidence of facial nerve weakness. Early consultation may help to manage short- and long-term functional difficulties.
描述桥小脑角手术后吞咽障碍，并探讨与术后吞咽困难发生率增加相关的变量。
病例系列，病历回顾。
单一学术医疗中心。
对 2008 年 1 月至 2010 年 12 月在约翰霍普金斯医院行桥小脑角病变手术切除的 181 例连续患者的病历进行回顾。通过语言病理学家的报告来确定吞咽困难的存在和特征。从电子病历中提取其他临床变量，并进行统计分析，以确定与术后吞咽困难相关的因素。
181 例患者中，有 57 例（31%）出现术后即刻吞咽困难。口腔、口咽和咽的缺陷分别占吞咽困难症状的 51%、37%和 12%。吞咽困难患者的面神经即刻术后无力占 91%，而无吞咽困难患者为 43%。吞咽困难患者的平均 House-Brackmann 评分是 4，无吞咽困难患者是 2。65%的吞咽困难患者需要改变饮食，另有 9%的患者需要管饲。视频透视吞咽研究的常见发现是咽部残留物、咽缩肌减少和前向食团丢失。行视频透视吞咽研究的患者中，异常的渗透-吸入评分（≥3）占 59%。
桥小脑角手术后常出现口腔和咽部吞咽障碍。对于任何表现出术后颅神经功能障碍的患者，特别是那些有面神经无力证据的患者，与语言病理学家咨询似乎最为关键。早期咨询可能有助于管理短期和长期的功能困难。
