Palatal adhesion: the treatment of unilateral palatal paralysis after high vagus nerve injury.
BACKGROUND
Resection of skull base tumors commonly necessitates intraoperative sacrifice of lower cranial nerves at the level of the jugular foramen. Sequelae of unilateral vagus nerve loss include ipsilateral laryngeal paralysis, ipsilateral palatal and pharyngeal paralysis, and velopharyngeal incompetence (VPI) marked by hypernasal speech and nasopharyngeal reflux of liquids during swallowing.


METHODS
Palatal adhesion (PA), a procedure whereby the unilaterally paralyzed palate is attached to the posterior pharyngeal wall, decreases the size of the velopharyngeal port and minimizes the symptoms. This study assessed the outcome of PA in 31 patients with VPI secondary to proximal vagus nerve injury.


RESULTS
PA decreased postoperative nasality in 96% of patients. Nasopharyngeal reflux was significantly improved in 83%. Three patients (11%) had minor wound breakdown postoperatively, all of which healed completely with conservative management.


CONCLUSIONS
PA offers a favorable result with minimal concomitant morbidity and is recommended for patients with VPI secondary to unilateral proximal vagus nerve paralysis.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, S-2100 Medical Center North, Nashville, Tennessee 37232-2559, USA. james.l.netterville@mcmail.vanderbilt.edu
James L
JL
Netterville
Scott
S
Fortune
Steve
S
Stanziale
Cheryl R
CR
Billante
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction; D009302:Nasopharyngeal Diseases / Q000175:diagnosis; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D010159:Palate / Q000294:innervation* / Q000601:surgery*; D010243:Paralysis / Q000150:complications / Q000209:etiology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000150:complications / Q000601:surgery; D012893:Sleep Wake Disorders; D013061:Speech Acoustics; D016896:Treatment Outcome; D061223:Vagus Nerve Injuries; D014681:Velopharyngeal Insufficiency / Q000209:etiology* / Q000601:surgery*; D014833:Voice Quality; D014945:Wound Healing