Postoperative Dysphagia Management in Hemifacial Spasm: A Case Report of Combined Catheter Balloon and Neuromuscular Stimulation

BACKGROUND Hemifacial spasm is a frequently encountered cranial nerve disorder caused by vascular compression, and microvascular decompression is considered the criterion standard treatment, particularly for cases resistant to pharmacological or botulinum toxin therapy. Although microvascular decompression is generally safe, it carries the risk of cranial nerve complications. Glossopharyngeal and vagus nerve dysfunction can result in cricopharyngeal dysfunction, leading to significant postoperative dysphagia characterized by poor upper esophageal sphincter (UES) opening, aspiration, and pharyngeal residue. Early and effective rehabilitation is critical but rarely documented in such cases. CASE REPORT We present a case of a 58-year-old man who developed severe dysphagia following microvascular decompression for left-sided hemifacial spasm. Postoperative videofluoroscopic swallowing study (VFSS) confirmed cricopharyngeal dysfunction, showing delayed hyoid elevation and restricted UES opening. A comprehensive rehabilitation protocol was initiated, combining neuromuscular electrical stimulation (NMES) with balloon-guided volitional swallowing training (CBD). NMES targeted submental and laryngeal regions to facilitate muscle activation and enhance sensory feedback. CBD involved repeated, guided swallowing with balloon catheter assistance to promote UES opening. After 2 weeks of daily therapy, VFSS showed significant improvement in UES relaxation and pharyngeal clearance. The patient transitioned from nasogastric feeding to full oral intake, with a functional oral intake scale score of 6. CONCLUSIONS Cricopharyngeal dysfunction is a rare but disabling complication following microvascular decompression. This case demonstrates that early, combined rehabilitative approaches - especially integration of NMES and volitional CBD - can lead to meaningful recovery of swallowing function and better patient outcomes.