[Dysphagia] Labial paresis

[eripley at yahoo.com (Irene Campbell-Taylor)]

         It must be determined whether or not the nerve damage is resection or stretching. In the former case, nothing can be done, in the latter, it will recover on its own. The motor innervation to the perioral musculature uniformly is from the seventh cranial nerve. The facial nerve has temporal, zygomatic, buccal, marginal mandibular, and cervical branches. The buccal and marginal branches primarily supply innervation to the perioral musculature. Interconnection between the branches is common, with at least 4 connections formed after exiting the parotid gland. The fibers supply the majority of the muscles of the face from their undersurface.See:
       
     
   
  Laryngeal and cranial nerve involvement after carotid endarterectomy 
  Authors: Simonetta Monini a;  Maurizio Taurino b;  Maurizio Barbara a;  Luigi Irace c;  Jihad Jabbour c;  Giorgio Bandiera a;  Ida Eliseo a; Vittorio Faraglia b 
  Published in: Acta Oto-Laryngologica, Volume 125, Issue 4 April 2005 , pages 398 - 402 
   
   
  
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          Conclusions Laryngeal and/or cranial nerve involvement after CEA surgery is not a rare condition, occurring in almost half of operated subjects. However, in most cases the functional deficit is transient and does not need any particular form of treatment. In this study, specific rehabilitative procedures were needed in only a relatively small number of cases (9%). A routine ENT examination has also proved to be extremely useful for detecting slight functional deficits which may occur following CEA surgery, bearing in mind that possible permanent lesions may require a rehabilitative procedure. 

Objective To identify, by means of a careful otolaryngologic examination, the incidence and degree of cranial nerve deficit related to carotid endarterectomy (CEA), starting from the first postoperative days. 

Material and methods A consecutive cohort of patients with symptomatic and asymptomatic carotid artery stenosis who underwent CEA was carefully followed on the basis of possible laryngeal and/or cranial nerve involvement. An ENT examination was carried out preoperatively (phase I) and at different times [3 (phase II) and 15 days (phase IIIa)] after surgery; in addition, patients with persisting neurological lesions were also checked 60 days after surgery (phase IIIb). 

Results In 59% of the patients, isolated or associated forms of deficit were found. Only 17.5% of these deficits did not appear to be transient, but rehabilitative procedures for voice or swallowing impairments were only needed in 9% of them. 
  
   
   
          Cranial nerve injuries following carotid endarterectomy: An analysis of 336 procedures
      Dr. Anthony J. Maniglia, MD *, D. Peter Han, MD
      Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio
  *Correspondence to Anthony J. Maniglia, Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Cleveland, 2074 Abington Road, Cleveland, OH 44106
          Head & Neck
  Volume 13, Issue 2 , Pages 121 - 124
   
   
          Cranial nerve injuries may result from carotid endarterectomy. From January 1984 to December 1987, a total of 336 carotid endarterectomies were performed at University Hospitals of Cleveland and Cleveland Veterans Administration Hospital. Forty-five cranial nerve injuries were documented (13.5%). Twenty patients (6%) had documented unilateral vocal cord paralysis, 16 (4.8%) had hypoglossal injuries, 8 (2.4%) had facial nerve paresis, and 1 (0.3%) had an injury to the spinal accessory nerve. Although most injuries were due to either retraction or edema of cranial nerves, long-term follow-up regarding recovery of function is very important. We feel that proper clinical evaluation of these patients should be routinely done preoperatively in order to document possible preexisting cranial nerve deficits. Postoperatively, if symptoms of possible cranial nerve abnormalities occur, these patients should have a thorough head and neck evaluation in order to identify
 possible lesions and institute further treatment to improve their quality of life.
      Cardiovasc Surg (Torino). 1988 Jul-Aug;29(4):432-6.
     
            
Local neurological complication during carotid endarterectomy.

Aldoori MI, Baird RN.

Department of Surgery, Bristol Royal Infirmary, U.K.

In a prospective study of 52 carotid endarterectomies there were 13 temporary cranial nerve injuries in 12 patients (25%); 7 hypoglossal nerve injuries (13.5%), 3 were asymptomatic (5.8%), 2 had mild speech difficulty (3.8%) and 2 had severe difficulty with deglutition and articulation (3.8%). A full recovery was made within 3 months in all 7 patients. Although 10 patients (19.2%) developed a hoarse voice, indirect laryngoscopy only indicated damage to the ipsilateral recurrent laryngeal nerve in 3 patients (5.8%). Both the voice and vocal cord movement returned to normal within 6 months in 2 patients and a 9 months in the third. The marginal mandibular branch of the facial nerve was injured in 3 patients (5.8%) and all recovered completely within 3 months. Following injury to the great auricular and the transverse cervical nerves injury, 13 patients (25%) had persistent irritation and paraesthesia during shaving and in cold weather lasting up to 18 months after operation.
 Carotid endarterectomy is associated with a much higher incidence of local nerve injury than retrospective surveys would indicate.
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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