Dysphagia is a debilitating symptom with many different causes and can take many different forms and degrees of severity. In the majority of cases in a maxillofacial surgery context, dysphagia will be managed by non-surgical means. These approaches can be divided into adaptive strategies (such as modified food textures) and compensatory approaches (such as specialised swallowing manoeuvres) for chronic forms of dysphagia. Non-surgical management may include reassurance and advice on coping strategies, nutritional advice, swallowing exercises, training to learn special swallowing manoeuvres, and repeated swallowing assessments over time to ensure safe swallowing.
Many acute forms of dysphagia that are entirely or mainly due to the acute phase of the underlying cause and/or its treatment typically resolve over time and may not need any further treatment.
Many of the surgical interventions aiming to treat the cause of dysphagia are not within the remit of oral & maxillofacial surgery but are carried out in ENT (ear, nose, and throat) or gastrointestinal surgery. For example, endoscopic dilation and laser ablation of pharyngeal constrictions lie within the field of ENT surgery, and middle and lower oesophageal causes within the field of gastroenterology. Surgical interventions from a maxillofacial perspective include
- removal of salivary glands or relocation of salivary gland ducts for the management of sialorrhea (severe drooling);
- placement of a percutaneous endoscopic gastrostomy (PEG) to enable enteral (tube) feeding to maintain nutrition in the presence of severe dysphagia;
- placement of a tracheostomy in order to protect the airway in cases of acute and severe aspiration;
- repair and reconstruction of cleft lip & palate and other craniofacial congenital anomalies;
- correction of velopharyngeal (soft palate) incompetence.
Next section: Dysphagia