Favorable Swallowing Outcomes following Vagus Nerve Sacrifice for Vagal Schwannoma Resection

• Published in: Otolaryngology-head and neck surgery Vol. 156; no. 2; p. 329
• Main Authors: Patel, Mira A, Eytan, Danielle F, Bishop, Justin, Califano, Joseph A
• Format: Journal Article
• Language: English
• Published: England 01.02.2017
• Subjects: Adolescent; Adult; Cranial Nerve Neoplasms - surgery; Deglutition - physiology; Female; Humans; Male; Middle Aged; Neurilemmoma - surgery; Treatment Outcome; Vagus Nerve - surgery; Vocal Cords - surgery; dysphagia; swallow; schwannoma; vagus; vagal sacrifice
• ISSN: 1097-6817
• DOI: 10.1177/0194599816678210

Objective To determine the impact of unilateral vagal sacrifice for vagal schwannoma on postoperative swallowing function. Study Design Case series, chart review. Setting Academic medical institution. Subjects and Methods Ten patients underwent vagus nerve sacrifice for vagal schwannoma resection. Archived pathology records dating from 1985 through 2012 at our institution were retrospectively queried for cases of vagal schwannoma with vagus nerve sacrifice. Medical records were abstracted for demographic and disease information as well as cranial nerve and swallowing function. Preoperative and postoperative cranial nerve function, subjective and objective measures of swallowing function, Functional Oral Intake Scale (FOIS) level, and need for vocal fold medialization were variables collected. Data were analyzed with summary statistics. Results The patients who underwent vagal sacrifice for vagal schwannoma at our institution had a mean age of 42.3 years (median, 44 years; range, 15-63 years) and follow-up of 35.6 months (median, 9 months; range, 1-115 months). Most presented with no preoperative cranial nerve deficit or difficulty swallowing. Immediately postoperatively, 90% had a vagus nerve deficit, but 50% had no subjective difficulty swallowing, and 70% had a FOIS level of 7 at postoperative hospital discharge. Within 1 month after surgery, 70% had normal swallowing function according to a modified barium swallow study. A full diet was tolerated by mouth within an average of 2.7 days (median, 2 days; range, 1-6 days) after surgery in this cohort. Seventy percent required vocal fold medialization postoperatively for incomplete glottic closure. Conclusion Vagal nerve sacrifice during resection of vagal schwannoma can be performed with normal postoperative swallowing function.