Swallowing in torticollis before and after rhizotomy

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.

Swallowing, speech, and brainstem auditory-evoked potentials in spasmodic torticollis

“…Fourth, the dysphagia may be neurogenic but peripheral, not central, in origin. Altered innervation or function of extrinsic laryngeal musculature (elevators and depressors) might allow a lower motor neuron explanation for the observed dysphagia [26,38]. Finally, the limited agreement between the swallowing and speech examinations is consistent with the idea that these motor functions have shared but not identical neural substrates [39,40].…”

“…These neurogenic signs (delayed reflex initiation and pharyngeal residue) are reminiscent of those seen in poststroke patients [30]. Riski and colleagues [22] observed such neurogenic signs frequently in a series of 43 torticollis patients evaluated before surgery, as did Horner and colleagues [26] in a unique series of torticollis patients undergoing rhizotomy. Comella and colleagues [31] also observed defective peristalsis in 4 of 15 torticollis patients before botulinum toxin injections.…”

“…In torticollis patients, postural dysphagia in isolation rarely if ever causes swallowing to be dysfunctional, but may account for, or contribute to patients' subjective complaints [22]. A priori operational definitions of the degree of swallowing abnormality were established relative to current knowledge about normal [24,25] and abnormal [21] swallowing: slight (asymmetry of pharyngeal transit only due to postural anomaly); mild (abnormal but adequate function in one of three phases); moderate (dysfunction in two or more phases); severe (dysfunction in all three phases, potentially including aspiration); see Homer et al for detailed operational definitions and rating scales [26].…”

Pompe disease diagnosis and management guideline

“…By using a scale such as the Penetration/Aspiration Scale the risk for laryngeal penetration and/or presence of aspiration can be assessed 62. Penetration of liquid into the laryngeal vestibule and aspiration has been documented as early as age 4 months in babies with Pompe disease (personal communication, Priya Kishnani, MD 2006).…”

“…Studies of the effect of strengthening in individuals with Pompe have been few, with small numbers and recommend the use of submaximal and aerobic exercise 62,75. Caution regarding exercise in the presence of myopathy and cardiorespiratory compromise is important.…”