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Jonathan E. Aviv, MD; Jay P. Mohr, MD; Andrew Blitzer, MD, DDS; Jeanne E. Thomson, MS, CCC/SLP; Lanny G. Close, MD

Arch Otolaryngol Head Neck Surg. 1997;123(2):154-160.

Abstract
Objective
To demonstrate that sensory nerve transposition may be used to reestablish sensation of the laryngopharynx after central nervous system injury and vagal deficit.

Design
Prospective preliminary report of 2 patients following brain-stem stroke with aspiration pneumonia confirmed on chest radiography, severe dysphagia and inability to tolerate oral alimentation, and modified barium swallow that demonstrated cricopharyngeal spasm and impaired laryngeal elevation. Both patients also had severe, bilateral laryngopharyngeal sensory deficits as determined by delivery of air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a fiberoptic telescope. Each patient underwent surgery as part of management of dysphagia after failure of aggressive nonsurgical treatment.

Intervention
During a cricopharyngeal myotomy and laryngeal suspension, a unilateral microneurorrhaphy between the greater auricular nerve and the superior laryngeal nerve was performed.

Outcome Measures
Ability to tolerate oral diet without development of aspiration pneumonia and postoperative laryngopharyngeal sensory capacity.

Results
By 12 months after surgery, both patients had ipsilateral restoration of laryngopharyngeal sensation, with no further episodes of aspiration pneumonia.

Conclusion
In select cases of severe dysphagia after central nervous system injury, sensory nerve transposition may be a useful adjunct to the surgical rehabilitation of the patient with dysphagia.

Arch Otolaryngol Head Neck Surg. 1997;123:154-160

Author Affiliations
From the Departments of Otolaryngology—Head and Neck Surgery (Drs Aviv and Close), Neurology (Dr Mohr), and Speech-Language Pathology (Ms Thomson), Columbia-Presbyterian Medical Center, and the Head and Neck Surgical Group, Department of Otolaryngology—Head and Neck Surgery, St Lukes/Roosevelt Hospital Center (Dr Blitzer), College of Physicians and Surgeons, Columbia University, New York, NY.

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