Related Experiment Video
Updated: May 28, 2026
Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion During Breathing and Swallowing
Published on: December 1, 2023
Prospective Dysphagia and Dysphonia Assessment After the Simplified Retropharyngeal Approach for Anterior Cervical
Pasquale De Bonis1,2,3, Roberta Alexandra Moldovan3, Sofia Bortolotti3
1Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy.
Background And Objectives:
Anterior access to the axial and upper subaxial cervical spine is anatomically constrained by the pharyngolaryngeal complex and adjacent neurovascular structures, and postoperative dysphagia/dysphonia remains clinically relevant after anterior approaches. The aim of this study was to prospectively quantify and explore predictors of patient-reported dysphagia and dysphonia after anterior cervical surgery performed through the Simplified Retropharyngeal (SR) approach.
Methods:
This single-center prospective cohort included consecutive patients undergoing anterior cervical spine surgery through the SR 4-step approach (October 2019-July 2024). Outcomes were assessed with the Dysphagia Handicap Index (DHI), Dysphagia Outcome and Severity Scale (DOSS), and Voice Handicap Index (VHI), preoperatively and postoperatively at different time points. Predictors of dysphagia at 7 days and dysphonia within 24 hours were explored using multivariable Firth penalized logistic regression.
Results:
Twenty patients (16 men, 4 women; mean age 59.5 years) were included; 45% were current smokers, and 75% had myelopathy. The mean operative time was 102 minutes. No intraoperative complications occurred. Postoperatively (≤24 hours), DHI >0 was reported by 90% (mean 10.1), DOSS was 7 (normal) in 80% and 6 (normal diet with modified independence) in 20%, and VHI >0 was reported by 50% (mean 7.7/120; range 1-20); in all patients, DHI and VHI returned to normal value by 180 days, and DOSS normalized within 7 days. No baseline covariate was significantly associated with DHI >0 at 7 days or VHI >0 at 24 hours.
Conclusion:
The SR approach was associated with frequent but transient patient-reported swallowing and voice symptoms, attributable to postoperative discomfort rather than true dysphagia, with complete recovery by the last follow-up. No functional impairment was detected on DOSS assessment. Larger controlled studies incorporating instrumental functional assessments are needed.
Related Concept Videos
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...