Dysphagia: Perioperative Risk Factors, Diagnosis and Treatment (pp. 89-104)
Authors: (P. Bradley Segebarth, Bruce Darden, OrthoCarolina Spine Center, Charlotte, North Carolina, USA)
Abstract: Swallowing disorders are a significant cause of morbidity and
mortality. Unrecognized dysphagia can lead to dehydration, malnutrition,
aspiration pneumonia, or airway difficulty. The etiology is numerous and
may be neurologic, muscular, or obstructive. Though many conditions
may be associated with dysphagia, iatrogenic causes are also common.
Anterior cervical spine surgery is often associated with varying degrees
of post-operative swallowing difficulties. Understanding the risk factors
as well as the anatomy and pathophysiology of swallowing should aid
diagnosis, treatment, and limitation of dysphagia complications.
After identifying there is a swallowing problem, the anatomic region
or involved phase should be recognized. History alone may be enough to
detect an esophageal etiology, but oral and pharyngeal phase problems
are best delineated by careful physical exam and diagnosis often aided by
radiographic and laboratory studies. Once cause is identified, treatment is
individualized based on structural and functional abnormalities. If
underlying cause of dysphagia is not treatable, a combination of dietary
modifications and swallowing therapy is often helpful. In some patients,
enteral therapy may be necessary in the short term or long term in
extreme cases in order to provide adequate nutrition.
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