An anatomical study of the pharyngeal plexus: Application to avoiding postoperative dysphagia following anterior approaches to the cervical spine

Iwanaga, Joe; Yılmaz, Emre; Loukas, Marios; Xu, Lu; Uz, Aysun; Walocha, Jerzy; Dumont, Aaron S.; Tubbs, R. Shane

doi:10.1002/ca.23785

Cited by 3 publications

(2 citation statements)

References 16 publications

(15 reference statements)

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“…This anatomical knowledge may aid in reducing the occurrence of nerve injury following cervical spine surgery. [ 51 ]…”

Section: Discussionmentioning

confidence: 99%

Transcervical, retropharyngeal odontoidectomy – Anatomical considerations

Yakdan,

Greenberg,

Krishnaney

et al. 2023

Journal of Craniovertebral Junction and Spine

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Context: Anterior craniocervical junction lesions have always been a challenge for neurosurgeons. Presenting with lower cranial nerve dysfunction and symptoms of brainstem compression, decompression is often required. While posterior approaches offer indirect ventral brainstem decompression, direct decompression via odontoidectomy is necessary when they fail. The transoral and endoscopic endonasal approaches have been explored but come with their own limitations and risks. A novel retropharyngeal approach to the cervical spine has shown promising results with reduced complications. Aims: This study aims to explore the feasibility and potential advantages of the anterior retropharyngeal approach for accessing the odontoid process. Methods and Surgical Technique: To investigate the anatomical aspects of the anterior retropharyngeal approach, a paramedian skin incision was performed below the submandibular gland on two cadaveric specimens. The subcutaneous tissue followed by the platysma is dissected, and the superficial fascial layer is opened. The plane between the vascular sheath laterally and the pharyngeal structures medially is entered below the branching point of the facial vein and internal jugular vein. After reaching the prevertebral plane, further dissection cranially is done in a blunt fashion below the superior pharyngeal nerve and artery. Various anatomical aspects were highlighted during this approach. Results: The anterior, submandibular retropharyngeal approach to the cervical spine was performed successfully on two cadavers highlighting relevant anatomical structures, including the carotid artery and the glossopharyngeal, hypoglossal, and vagus nerves. This approach offered wide exposure, avoidance of oropharyngeal contamination, and potential benefit in repairing cerebrospinal fluid fistulas. Conclusions: For accessing the craniocervical junction, the anterior retropharyngeal approach is a viable technique that offers many advantages. However, when employing this approach, surgeons must have adequate anatomical knowledge and technical proficiency to ensure better outcomes. Further studies are needed to enhance our anatomical variations understanding and reduce intraoperative risks.

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“…This anatomical knowledge may aid in reducing the occurrence of nerve injury following cervical spine surgery. [ 51 ]…”

Section: Discussionmentioning

confidence: 99%

Transcervical, retropharyngeal odontoidectomy – Anatomical considerations

Yakdan,

Greenberg,

Krishnaney

et al. 2023

Journal of Craniovertebral Junction and Spine

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“…The glossopharyngeal nerve exits the jugular foramen, descends between the ICA and IJV deep to the styloid process, then descends anterior to the stylopharyngeus muscle where it branches to innervate various tongue, pharynx, and hypopharynx muscles 4 . Relative to the spine, these branches enter the posterior pharyngeal wall at the C2-4 levels 16 . The glossopharyngeal nerve innervates the stylopharyngeus muscle, which elevates the larynx and opens the upper esophageal sphincter 17 .…”

Section: Literature Reviewmentioning

confidence: 99%

Hypoglossal and Glossopharyngeal Nerve Palsy After Anterior Cervical Decompression and Fusion

Simon,

Du,

Parel

et al. 2024

JBJS Case Connector

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Case: A 69-year-old man underwent a C3-4 anterior cervical discectomy and fusion and developed postoperative hypoglossal and glossopharyngeal palsies that resolved with symptomatic treatment. Conclusion: Cranial nerve palsy is a rare and possibly under-reported injury after higher-level cervical spine surgery. Conscientious positioning and awareness of these nerves during surgical exposure are crucial to minimizing cranial nerve palsies. Proper workup to identify these palsies and differentiate them from other complications is necessary to guide proper treatment.

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Kinematic analysis of chewing and swallowing function after cervical spine surgery

Aritaki,

Nakagawa,

Yoshimi

et al. 2023

Eur Spine J

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Purpose Although movement of the hyoid bone is different for masticatory swallowing and liquid swallowing in normal subjects, it has not been studied after cervical spine surgery. Therefore, we analyzed the swallowing dynamics of masticatory swallowing in anterior cervical spine disease surgery using foods that require chewing close to actual meals. Methods A day before and one week after the surgery, a videofluoroscopic swallow study (VFSS) was performed, and the distance of hyoid bone movement in the anterior and superior directions, amount of opening of the upper esophageal sphincter (UES), time of passage through the pharynx, number of swallows, and amount of pharyngeal residual were measured on the VFSS images during a masticatory swallow of corn flakes. The swallowing function was evaluated by DSS (dysphagia severity scale) and FOIS (functional oral intake scale). Imaging software was used for the measurements. Results Postoperative hyoid movement during masticatory swallowing was not significantly different for anterior movement but significantly limited in upward movement (p = 0.002); UES opening volume was significantly decreased (p < 0.001), and bolus residue was significantly worse (p < 0.001), compared to preoperative. The pharyngeal transit time was not significantly different; the number of swallows increased (p < 0.001), along with DSS (p < 0.001) and FOIS (p < 0.001), with significant differences before and after surgery, indicating worsened swallowing function. Conclusions Swallowing function worsened in masticatory swallowing after surgery for cervical spine disease, mainly due to the restriction of upward movement of the hyoid bone and the resulting increase in pharyngeal residuals after swallowing.

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An anatomical study of the pharyngeal plexus: Application to avoiding postoperative dysphagia following anterior approaches to the cervical spine

Cited by 3 publications

References 16 publications

Transcervical, retropharyngeal odontoidectomy – Anatomical considerations

Transcervical, retropharyngeal odontoidectomy – Anatomical considerations

Hypoglossal and Glossopharyngeal Nerve Palsy After Anterior Cervical Decompression and Fusion

Kinematic analysis of chewing and swallowing function after cervical spine surgery

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