Massachusetts Chapter of the American College of Surgeons

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Lower cranial Nerve Injury: Risk Assessment, Diagnosis, and Treatment
Martina Mustroph1, Rachel Wui2, Matthew R. Naunheim3, Wenya Linda Bi1
1Brigham & Women's Hospital, Department of Neurological Surgery, Boston, MA; 2School of Visual Arts, Boston, MA; 3Brigham & Women's Hospital, Massachusetts Eye and Ear Institute, Boston, MA

Background:
Injury of cranial nerves IX through XII from neoplastic pathologies and following surgical intervention poses significant morbidity and mortality to patients. Appropriate recognition, timely intervention, and appreciation of the natural history for recovery potential are critical to achieve safe outcomes when such injury occurs.

Methods:
In this review, we outline the anatomy and physiology of the lower cranial nerves and the functional consequences of their injury, with an emphasis on the time course of available therapeutic options for voice and swallow dysfunction.

Results:
We propose a sequential approach to the management of pre-operative and post-operative voice and swallow deficiencies and also highlight recent advances in lower cranial nerve functional restoration.

Conclusion:
With this knowledge, surgeons will be better equipped to anticipate and manage peri-operative lower cranial nerve injuries to optimize outcome in patients.


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