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[What is the value of the Denecke surgical therapy concept in deglutition disorders?]
1Klinik für HNO-Krankheiten Kopf-, Hals- und Plastische Gesichtschirurgie, Kommunikationsstörungen, Klinikum Fulda. rainer.weber@medizin.uni-magdeburg.de
Background:
Denecke developed 1957 a surgical strategy consisting of three or four operative steps for rehabilitation of patients with unilateral paralysis of IXth and Xth cranial nerve. These four steps are the following: myotomy of the cricopharyngeal muscle, resection of the paralyzed pharyngeal wall, medialization of the paralyzed vocal cord and fixation of the soft palate to the posterior pharyngeal wall which can be facultative.
Patients And Methods:
For the first time we have reviewed patients operated on with the Denecke operation in a retrospective study. The surgical results should be analyzed to deduce some parameters for surgical indication.
Results:
16 patients were reviewed in regard to nourishment status, situation of tracheostomy, former pneumonias, classification of Miller and Eliachar for aspiration and subjective evaluation. The follow-up was 21 +/- 16 months postoperatively. In 8 cases surgical intervention was successful. In 2 additional cases the results were partially satisfying.
Conclusions:
The surgical procedure of Denecke was successful for improving substantially nourishment and aspiration status of considerably reduced patients in about 50% of the reviewed cases. Preoperative cinematography of swallowing, manometry and an interdisciplinary approach are required to clearly define the indications for surgical intervention.