gms | German Medical Science

The complex swallowing process is controlled bilaterally by the cranial nerves V, VII, IX, X, XII, but the influence of the vagus innervation is dominant in the motor function. Failure of only one vagus pathway can result in the clinical picture of paralytic dysphagia, characterized by intradeglutitive and postdeglutitive aspiration.

Due to the use of modern surgical techniques (microscope, intraoperative neuromonitoring, navigation), the complete or incomplete cranial nerve paralysis that occurs following surgical procedures at the base of the skull is often temporary, with complete restitutio ad integrum within few months’ time.

Good results have been obtained to date with two transoral endoscopic techniques performed in the same session for swallowing rehabilitation. A successful alternative to conventional myotomy of the cricopharyngeal muscle has been shown to be denervation of this muscle by means of endoscopic injection of 20 IU of Botox into each of the 4 quadrants of the hypopharyngeo-oesophageal transition. In the same session, the paralyzed vocal fold is augmented endoscopically by means of collagen injection (0.8 – 1 ml Zyplast^®) to the point of complete glottis occlusion.

To ensure the success of subsequent functional deglutition therapy, the invasive endoscopic measures must be carried out in the early phase immediately following occurrence of the paralytic symptoms. A PEG catheter placed at the same time supports the rehabilitation process. Transnasal flexible endoscopy of the patient (VEED, FEES) is of inestimable value during functional dysphagia therapy. Leaving the fibre endoscope in situ during glutition facilitates visualization of the findings before and after swallowing.