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Oropharyngeal dysphagia due to iatrogenic neurological dysfunction

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Abstract

Oropharyngeal dysphagia due to iatrogenic neurological dysfunction may relate to either medication side effects or surgical complications. There are several general mechanisms by which neurological side effects of medications can cause or aggravate oropharyngeal dysphagia. These include decreased level of arousal, direct suppression of brainstem swallowing regulation, movement disorders (dyskinesias, dystonias, and parkinsonism), neuromuscular junction blockade, myopathy, oropharyngeal sensory impairment, and disturbance of salivation. Postsurgical oropharyngeal dysphagia due to neurological dysfunction has been described in association with carotid endarterectomy, esophageal cancer surgery, anterior cervical fusion, and ventral rhizotomy for spasmodic torticollis. A potential explanation for oropharyngeal dysphagia following these surgical procedures is intraoperative mechanical disruption of the innervation of the pharyngeal constrictor muscles by the pharyngeal plexus. Posterior fossa and skull base surgery can lead to dysphagia as a result of intraoperative damage to brainstem centers and/or cranial nerves involved in swallowing. Perioperative stroke is the most likely explanation for oropharyngeal dysphagia appearing acutely following surgery, especially if the type of surgery predisposes to embolism or hypoperfusion.

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References

  1. Kronenberger MB, Meyers AD: Dysphagia following head and neck cancer surgery. Dysphagia 9:236–244, 1994

    Google Scholar 

  2. Ekberg O, Nylander G: Pharyngeal dysfunction after treatment for pharyngeal cancer with surgery and radiotherapy. Gastrointestinal Radiology 8:97–104, 1983

    Google Scholar 

  3. Stoschus B, Allescher H-D: Drug-induced dysphagia. Dysphagia 8:154–159, 1993

    Google Scholar 

  4. Huxley EJ, Viroslav J, Gray WR, Pierce AK: Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 64:565–568, 1978

    Google Scholar 

  5. Wyllie E, Wyllie R, Cruse RP, Rothner AD, Erenberg G: The mechanism of nitrazepam-induced drooling and aspiration. N Engl J Med 314:35–38, 1986

    Google Scholar 

  6. Buchholz D, Jones B, Neumann S, Ravich W: Benzodiazepineinduced pharyngeal dysphagia: report of two possible cases (abstract) Presented at the Dysphagia Research Society Third Annual Scientific Meeting, 1994

  7. Hockman CH, Bieger D: Inhibitory effect of diazepam on reflexly-induced deglutition. Proc Canad Fed Biol Soc 22:85, 1979

    Google Scholar 

  8. Massengill R, Nashold B: A swallowing disorder denoted in tardive dyskinesia patients. Acta OtoLaryngol (Stockh) 68:457–458, 1969

    Google Scholar 

  9. Flaherty JA, Lahmeyer HW: Laryngeal-pharyngeal dystonia as a possible cause of asphyxia with haloperidol treatment. Am J Psychiatry 135:1414–1415, 1978

    Google Scholar 

  10. McDanal CE: Haloperidol and laryngeal-pharyngeal dystonia. Am J Psychiatry 138:1262–1263, 1981

    Google Scholar 

  11. Menuck M: Laryngeal-pharyngeal dystonia and haloperidol. Am J Psychiatry 138:394–395, 1981

    Google Scholar 

  12. Moss HB, Green A: Neuroleptic-associated dysphagia confirmed by esophageal manometry. Am J Psychiatry 139:515–516, 1982

    Google Scholar 

  13. Craig TJ, Richardson MA: Swallowing, tardive dyskinesia, and anticholinergics. Am J Psychiatry 139:1083, 1982

    Google Scholar 

  14. Craig TJ, Richardson MA, Bark NM, Klebanov R: Impairment of swallowing, tardive dyskinesia and anticholinergic drug use. Psychopharmacol Bull 18:83–86, 1982

    Google Scholar 

  15. Bosma JF, Geoffrey V, Thach B, Weiffenbach J, Kavanaugh T, Orr W: A pattern of medication-induced bulbar and cervical dystonia. Int J Orofac Myol 8:5–19, 1982

    Google Scholar 

  16. Samie MR, Dannenhoffer MA, Rozek S: Life-threatening tardive dyskinesia caused by metoclopramide. Mov Disord 2:125–129, 1987

    Google Scholar 

  17. Comella CL, Tanner CM, DeFoor-Hill L, Smith C: Dysphagia after botulinum toxin injections for spasmodic torticollis. Neurology 42:1307–1310, 1992

    Google Scholar 

  18. Kuncl RW, Wiggins WW: Toxic myopathies. Neurol Clin 6:593–619, 1988

    Google Scholar 

  19. Hochman RA, Martin JT, Devine KD: Anesthesia and the larynx. Surg Clin North Am 45:1031–1039, 1965

    Google Scholar 

  20. Taylor PA, Towey RM: Depression of laryngeal reflexes during ketamine anesthesia. Br Med J 2:688–690, 1971

    Google Scholar 

  21. Cleaton-Jones P: The laryngeal-closure reflex and nitrous oxide analgesia. Anesthesiology 45:569–570, 1976

    Google Scholar 

  22. Bonanno PC: Swallowing dysfunction after tracheostomy. Ann Surg 174:29–33, 1971

    Google Scholar 

  23. Bone DK, Davis JL, Zuidema GD, Cameron JL: Aspiration pneumonia. Ann Thorac Surg 18:30–37, 1974

    Google Scholar 

  24. Nash M: Swallowing problems in the tracheotomized patient. Otolaryngol Clin North Am 21(4):701–709, 1988

    Google Scholar 

  25. Spray SB, Zuidema GD, Cameron JL: Aspiration pneumonia: incidence of aspiration with endotracheal tubes. Am J Surg 131: 701–703, 1976

    Google Scholar 

  26. Greenberg DJ: The incidence of aspiration in patients with tracheostomies. Anesthes Analg 63:1142, 1984

    Google Scholar 

  27. Sasaki CT, Suzuki M, Horiuchi M, Kirchner JA: The effect of tracheostomy on the laryngeal closure reflex. Laryngoscope 87:1428–1433, 1977

    Google Scholar 

  28. Cameron JL, Reynolds J, Zuidema GD: Aspiration in patients with tracheostomies. Surg Gynecol Obstet 136:68–70, 1973

    Google Scholar 

  29. Bishop M, Weymuller EA, Fink BR: Laryngeal effects of prolonged intubation. Anesth Analg 63:335–42, 1984

    Google Scholar 

  30. de Larminat V, Montravers P, Durevil B, Desmonts J-M: Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med 23:486–490, 1995

    Google Scholar 

  31. Hughes CV, Baum BJ, Cox PC, Marmary Y, Yeh CK, Sonies BC: Oropharyngeal dysphagia: a common sequel of salivary gland dysfunction. Dysphagia 1:173–177, 1987

    Google Scholar 

  32. Kaplan MD, Baum BJ: The functions of saliva. Dysphagia 8:225–229, 1933

    Google Scholar 

  33. Bazemore PH, Tonkonogy J, Ananth R, Colby J: Clozapine treatment and an unusual type of dysphagia. Dysphagia 10:62, 1995

    Google Scholar 

  34. Ekberg O, Bergqvist D, Takolander R, Uddman R, Kitzing P: Pharyngeal function after carotid endarterectomy. Dysphagia 4:151–154, 1989

    Google Scholar 

  35. Hambraeus GM, Ekberg O, Fletcher R: Pharyngeal dysfunction after total and subtotal oesophagectomy. Acta Radiol 28:409–413, 1987

    Google Scholar 

  36. Heitmiller RF, Jones B: Transient diminished airway protection following transhiatal esophagectomy. Am J Surg 162:422–446, 1991

    Google Scholar 

  37. Henderson RD, Boszko A, vanNostrand AWP: Pharyngoesophageal dysphagia and recurrent laryngeal nerve palsy. J Thorac Cardiovasc Surg 68:507–512, 1974

    Google Scholar 

  38. Ong GB, Lam KH, Lam PHM, Wong J: Resection for carcinoma of the superior mediastinal segment of the esophagus. World J Surg 2:497–504, 1978

    Google Scholar 

  39. Hirano M, Tanaka S, Fujita M, Fujita H: Vocal cord paralysis caused by esophageal cancer surgery. Ann Otol Rhinol Laryngol 102:182–185, 1993

    Google Scholar 

  40. Flynn TB: Neurologic complications of anterior cervical interbody fusion. Spine 7:536–539, 1982

    Google Scholar 

  41. Bulger RF, Rejowski JE, Beatty RA: Vocal cord paralysis associated with anterior cervical fusion: considerations for prevention and treatment. J Neurosurg 62:657–661, 1985

    Google Scholar 

  42. Welsh LW, Welsh JJ, Chinnici JC: Dysphagia due to cervical spine surgery. Ann Otol Rhinol Otolaryngol 96:112–115, 1987

    Google Scholar 

  43. Graham JJ: Complications of cervical spine surgery. A five-year report on a survey of the membership of the Cervical Spine Reseacch Society by the Morbidity and Mortality Committee. Spine 14:1046–1050, 1989

    Google Scholar 

  44. Bertalanffy H, Eggert H-R: Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wein) 99:41–50, 1989

    Google Scholar 

  45. Clements DH, O'Leary PF: Anterior cervical discectomy and fusion. Spine 15:1023–1025, 1990

    Google Scholar 

  46. Ogle K, Palsingh J, Hewitt C, Anderson M: Osteoptysis: a complication of cervical spine surgery. Br J Neurosurg 6:607–609, 1992

    Google Scholar 

  47. Buchholz DW, Jones B, Ravich WJ: Dysphagia following anterior cervical fusion. Dysphagia 8:390,1993

    Google Scholar 

  48. Horner J, Riski JE, Levitt-Ovelmen J, Nashold BS: Swallowing in torticollis before and after hizotomy. Dysphagia 7:117–125, 1992

    Google Scholar 

  49. Schröter-Morasch H, Winkler R, Lumenta C: Dysphagia after posterior fossa tumor surgery (abstract) Presented at the Dysphagia Research Society Third Annual Meeting, 1994

  50. Buchholz DW: Clinically probable brainstem stroke presenting primarily as dysphagia and nonvisualized by MRI. Dysphagia 8:235–238, 1993

    Google Scholar 

  51. Buchholz D, Neumann S, Jones B, Ravich W: Neurogenic dysphagia: results of swallowing center neurologic evaluation of 228 cases. Dysphagia 10:137, 1995

    Google Scholar 

  52. Neumann S, Buchholz D, Wuttge-Hannig A, Hannig C, Prosiegel M, Schröter-Morasch H: Bilateral pharyngeal dysfunction after lateral medullary infarction. Dysphagia 9:253, 1994

    Google Scholar 

  53. Neumann S, Buchholz D, Jones B, Palmer J: Pharyngeal dysfunction after lateral medullary infarction is bilateral: review of 15 additional cases. Dysphagia 10:136, 1995

    Google Scholar 

  54. Levine TM: Swallowing disorders following skull base surgery. Otolaryngol Clin North Am 21:751–750, 1988

    Google Scholar 

  55. Jennings KS, Siroky D, Jackson CG: Swallowing problems after excision of tumors of the skull base: diagnosis and management in 12 patients. Dysphagia 7:40–44, 1992

    Google Scholar 

  56. Ricotta JJ, Saggioli GL, Castilone A, Hassett JM: Risk factors for stroke after cardiac surgery: Buffalo Cardiac-Cerebral Study Group. J Vasc Surg 21:359–364, 1995

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    David W. Buchholz M.D.

  2. The Johns Hopkins Outpatient Center, Baltimore, Maryland, USA

    David W. Buchholz M.D.

  3. The Johns Hopkins Swallowing Center, Baltimore, Maryland, USA

    David W. Buchholz M.D.

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  1. David W. Buchholz M.D.
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Buchholz, D.W. Oropharyngeal dysphagia due to iatrogenic neurological dysfunction. Dysphagia 10, 248–254 (1995). https://doi.org/10.1007/BF00431417

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