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J Neurol Surg B Skull Base
DOI: 10.1055/a-2732-5803
Review Article

Assessment and Management of Lower Cranial Nerve Injury

Authors

  • Martina L. Mustroph 

    1   Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

  • Rachel Wui

    2   School of Visual Arts, Boston University, Boston, Massachusetts, United States

  • Matthew R. Naunheim

    3   Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, Massachusetts, United States

  • Wenya Linda Bi

    1   Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Abstract

Introduction

Injury of lower cranial nerves XI and X poses significant morbidity and mortality to patients. Appropriate recognition, timely intervention, and appreciation of the natural history for recovery potential are critical to achieve safe outcomes when such injury occurs.

Methods/Design

To outline the most effective ways to assess and manage lower cranial nerve injuries, we propose a sequential approach to the management of preoperative and postoperative voice and swallow deficiencies from lower cranial nerve injuries.

Setting

Injury of cranial nerves IX and X from neoplastic pathologies and following surgical intervention poses significant morbidity and mortality to patients. Appropriate recognition, timely intervention, and appreciation of the natural history for recovery potential are critical to achieve safe outcomes when such injury occurs.

Participants

Patients with injury of cranial nerves IX through XII from neoplastic pathologies and following surgical intervention.

Main Outcome Measures

In this narrative review, we outline the anatomy and physiology of the lower cranial nerves IX and X and the functional consequences of their injury, with an emphasis on the time course of available therapeutic options for voice and swallow dysfunction.

Results

We propose a sequential approach to the management of preoperative and postoperative voice and swallow deficiencies.

Conclusion

With this knowledge, surgeons will be better equipped to anticipate and manage perioperative lower cranial nerve injuries to optimize outcome in patients.

Keywords

lower cranial nerves - dysphagia - dysphonia - aspiration - cranial nerve rehabilitation


Publication History

Received: 14 November 2023

Accepted: 26 October 2025

Article published online:
27 November 2025

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