Swallowing in torticollis before and after rhizotomy |
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Authors: | Jennifer Horner PhD John E Riski PhD Janice Ovelmen-Levitt PhD Blaine S Nashold Jr MD |
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Institution: | (1) Speech and Language Pathology Program, Department of Surgery, Duke University Medical Center, Box 3887, 27710 Durham, North Carolina, USA;(2) Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3887, 27710, North Carolina, USA |
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Abstract: | To determine risk factors for dysphagia after ventral rhizotomy, videofluoroscopic barium swallowing examinations were done
on 41 spasmodic torticollis patients before and after surgery. Radiologic abnormalities were present in 68.3% of the patients
before surgery, but these were only mildly abnormal in the majority. After surgery 95.1% showed radiologic abnormalities which
were moderate or severe in one-third of the patients. Swallowing abnormalities correlated significantly with duration of torticollis
and subjective complaints of swallowing difficulty both before and after surgery, but not with age, sex, or type of torticollis.
The major acute postoperative finding was aggravation of preexisting pharyngeal dysfunction. Follow-up from about half of
our original sample showed that gradual improvement occurred from 4 to 24 weeks after surgery by subjective report. We review
the innervation of intrinsic and extrinsic pharyngeal musculature, and suggest that C1–3 rhizotomies and selective sectioning
of the spinal accessory nerve are responsible for aggravation of pharyngeal swallowing dysfunction in the acute postsurgical
period. |
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Keywords: | Spasmodic torticollis Dysphagia Videofluoroscopy Barium swallow Rhizotomy Deglutition Deglutition disorders |
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