Palatal adhesion: The treatment of unilateral palatal paralysis after high vagus nerve injury

✍ Scribed by James L. Netterville; Scott Fortune; Steve Stanziale; Cheryl R. Billante

• Publisher: John Wiley and Sons
• Year: 2002
• Tongue: English
• Weight: 133 KB
• Volume: 24
• Category: Article
• ISSN: 1043-3074
• DOI: 10.1002/hed.10134

✦ Synopsis

Abstract

Background

Resection of skull base tumors commonly necessitates intraoperative sacrifice of lower cranial nerves at the level of the jugular foramen. Sequelae of unilateral vagus nerve loss include ipsilateral laryngeal paralysis, ipsilateral palatal and pharyngeal paralysis, and velopharyngeal incompetence (VPI) marked by hypernasal speech and nasopharyngeal reflux of liquids during swallowing.

Methods

Palatal adhesion (PA), a procedure whereby the unilaterally paralyzed palate is attached to the posterior pharyngeal wall, decreases the size of the velopharyngeal port and minimizes the symptoms. This study assessed the outcome of PA in 31 patients with VPI secondary to proximal vagus nerve injury.

Results

PA decreased postoperative nasality in 96% of patients. Nasopharyngeal reflux was significantly improved in 83%. Three patients (11%) had minor wound breakdown postoperatively, all of which healed completely with conservative management.

Conclusion

PA offers a favorable result with minimal concomitant morbidity and is recommended for patients with VPI secondary to unilateral proximal vagus nerve paralysis. © 2002 Wiley Periodicals, Inc. Head Neck 24: 721–730, 2002