Rehabilitation of the Patient with a Postoperative Jugular Foramen Syndrome

Abstract

The pharyngeal phase of swallowing depends on the intact function of the vagus and glossopharyngeal nerves. An intact hypoglossal nerve is also essential to initiate this second phase of swallowing. Pathology of the jugular foramen often results in paralysis of these nerves. The loss of function tends to occur slowly and this allows compensatory mechanisms to preserve a relatively normal swallow and voice. Later in the natural history axonal degeneration and neurotmesis cause wasting of the laryngopharyngeal musculature and clinically disturbed swallowing or dysphagia occurs. If these nerves are damaged perioperatively either with some pre-existing weakness or from direct surgical trauma, the resulting dysphagia is more acute and may be clinically very significant.The importance of these nerves for normal swallowing and voice is emphasized and a systematic approach to the management and rehabilitation of these distressing complications is discussed. This starts with the modification of the initial surgical resection and considers the role of postoperative radiotherapy. Hypoglossal preservation is vital to prevent severe swallowing problems. Finally, the management and rehabilitation of the patient with jugular foramen syndrome is detailed.