Characteristics of Dysphagia after Cerebellopontine Angle Surgery

Abstract

Objective: Describe swallowing disorders encountered after Cerebellopontine Angle (CPA) surgery as well as to explore variables associated with increased incidence of postoperative dysphagia. Method: Retrospective chart review of 181 consecutive patients undergoing surgical excision of CPA pathology from January 1, 2008, to December 31, 2010, at Johns Hopkins Hospital. Presence and characteristics of dysphagia were determined by speech pathologist reports. Clinical variables were extracted from the electronic medical record. Results: Postoperative dysphagia was identified in 57 out of 181 patients (31%). Oral, oropharyngeal, and pharyngeal deficits accounted for 49%, 37%, and 12% of dysphagic symptoms respectively. Facial nerve weakness in the immediate postoperative period was noted in 91% of dysphagic subjects (mean House-Brackmann score of 4) compared with 43% of those without dysphagia (mean House-Brackman score of 2). Diet alterations were required for 65% of dysphagic individuals, and an additional 9% required tube-feeding. Common findings during Videofluoroscopic Swallowing Studies (VFSS) were pharyngeal residue, reduced pharyngeal constriction, and anterior bolus loss. Abnormal Penetration-Aspiration Scores (≥3) were found in 59% of those undergoing VFSS. Conclusion: Oral and pharyngeal swallowing deficits are commonly encountered after CPA surgery. Consultation with a speech-language pathologist appears most critical for any individuals demonstrating postoperative cranial nerve dysfunction, particularly for those with evidence of facial nerve weakness. Early consultation may help to manage short- and long-term functional difficulties.