Videofluoroscopy-Guided Balloon Dilatation for the Opening Dysfunction of Upper Esophageal Sphincter by Postoperative Vagus Nerve Injury: A Report on Two Cases

Abstract

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.

Effectiveness of Rehabilitative Balloon Swallowing Treatment on Upper Esophageal Sphincter Relaxation and Pharyngeal Motility for Neurogenic Dysphagia

“…This method incorporated the idea of dilatation, but instead of keeping the balloon in the expanded state at the UES for some time, it mainly utilized iterative swallowing responses, which could be spontaneous, voluntary, or reflexive by irritation of the nerve plexus by the expanded balloon. Recently, Jung et al [ 14 ] reported cases of two patients, who were able to take oral feeding after application of technique suggested by Kim et al [ 13 ] in patients with UES dysfunction due to vagus nerve injury after a surgical intervention.…”

Simultaneous double balloon dilatation using double channel therapeutic endoscope in patients with cricopharyngeal muscle dysfunction

“…[ 21 – 23 ] In other ways, there are some reports of cricopharyngeal balloon dilatation using urethral catheters under fluoroscopic guidance, showing pharyngoesophageal function improvements. [ 24 – 26 ] In a study that used high-resolution manometry, balloon dilatation using urethral catheters for CPD improved UES relaxation, restored UES resting pressure, strengthened pharyngeal propulsion, and improved functional oral intake, compared with regular therapy alone. [ 27 ] Alternatively, RBS is a safer approach than mechanical balloon dilatation of the UES.…”