RESTORATION OF LARYNGOPHARYNGEAL SENSATION BY NEURAL ANASTOMOSIS

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 repor t of 2 patients following brain-stem stroke with aspiration pneumonia confirmed on chest radiography, severe dysphagia and inability to tole rate oral alimentation, and modified barium swallow that demonstrated cricopharyngeal spasm and impaired laryngeal elevation. Both patients also had severe, bilateral laryngopharyngeal sensory deficits as deter mined by delivery of air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a fiberoptic telescope. Each patient und erwent surgery as part of management of dysphagia after failure of agg ressive nonsurgical treatment. Intervention: During a cricopharyngeal myotomy and laryngeal suspension, a unilateral microneurorrhaphy betwe en the greater auricular nerve and the superior laryngeal nerve was pe rformed. Outcome Measures: Ability to tolerate oral diet without devel opment of aspiration pneumonia and postoperative laryngopharyngeal sen sory capacity. Results: By 12 months after surgery, both patients had ipsilateral restoration of laryngopharyngeal sensation, with no furthe r episodes of aspiration pneumonia. Conclusion: In select cases of sev ere dysphagia after central nervous system injury, sensory nerve trans position may be a useful adjunct to the surgical rehabilitation of the patient with dysphagia.