Zhang Qian, Wu Shuang, Shi Yangmei, Chen Qian, Gao Jiajie
Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
Department of Rehabilitation, Guizhou Medical University, Guiyang, Guizhou, China.
Am J Case Rep. 2025 Jun 24;26:e948795. doi: 10.12659/AJCR.948795.
BACKGROUND Hemifacial spasm is a frequently encountered cranial nerve disorder caused by vascular compression, and microvascular decompression is considered the criterion standard treatment, particularly for cases resistant to pharmacological or botulinum toxin therapy. Although microvascular decompression is generally safe, it carries the risk of cranial nerve complications. Glossopharyngeal and vagus nerve dysfunction can result in cricopharyngeal dysfunction, leading to significant postoperative dysphagia characterized by poor upper esophageal sphincter (UES) opening, aspiration, and pharyngeal residue. Early and effective rehabilitation is critical but rarely documented in such cases. CASE REPORT We present a case of a 58-year-old man who developed severe dysphagia following microvascular decompression for left-sided hemifacial spasm. Postoperative videofluoroscopic swallowing study (VFSS) confirmed cricopharyngeal dysfunction, showing delayed hyoid elevation and restricted UES opening. A comprehensive rehabilitation protocol was initiated, combining neuromuscular electrical stimulation (NMES) with balloon-guided volitional swallowing training (CBD). NMES targeted submental and laryngeal regions to facilitate muscle activation and enhance sensory feedback. CBD involved repeated, guided swallowing with balloon catheter assistance to promote UES opening. After 2 weeks of daily therapy, VFSS showed significant improvement in UES relaxation and pharyngeal clearance. The patient transitioned from nasogastric feeding to full oral intake, with a functional oral intake scale score of 6. CONCLUSIONS Cricopharyngeal dysfunction is a rare but disabling complication following microvascular decompression. This case demonstrates that early, combined rehabilitative approaches - especially integration of NMES and volitional CBD - can lead to meaningful recovery of swallowing function and better patient outcomes.
面肌痉挛是一种常见的由血管压迫引起的颅神经疾病，微血管减压术被认为是标准治疗方法，尤其是对于药物或肉毒毒素治疗无效的病例。尽管微血管减压术一般是安全的，但存在颅神经并发症的风险。舌咽神经和迷走神经功能障碍可导致环咽肌功能障碍，导致明显的术后吞咽困难，表现为食管上括约肌（UES）开放不良、误吸和咽部残留。早期有效的康复治疗至关重要，但此类病例中很少有记录。病例报告：我们报告一例58岁男性，在接受左侧面肌痉挛微血管减压术后出现严重吞咽困难。术后视频荧光吞咽造影检查（VFSS）证实环咽肌功能障碍，表现为舌骨抬高延迟和UES开放受限。启动了一项综合康复方案，将神经肌肉电刺激（NMES）与球囊引导的自主吞咽训练（CBD）相结合。NMES针对颏下和喉部区域，以促进肌肉激活并增强感觉反馈。CBD包括在球囊导管辅助下反复进行引导吞咽，以促进UES开放。经过两周的每日治疗，VFSS显示UES松弛和咽部清除有显著改善。患者从鼻饲过渡到完全经口进食，功能性经口进食量表评分为6分。结论：环咽肌功能障碍是微血管减压术后一种罕见但致残的并发症。本病例表明，早期联合康复方法——尤其是NMES和自主CBD的结合——可导致吞咽功能有意义的恢复，并改善患者预后。
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