Assessment and Management of Lower Cranial Nerve Injury

Abstract 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. 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. 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. Patients with injury of cranial nerves IX through XII from neoplastic pathologies and following surgical intervention. 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. We propose a sequential approach to the management of preoperative and postoperative voice and swallow deficiencies. With this knowledge, surgeons will be better equipped to anticipate and manage perioperative lower cranial nerve injuries to optimize outcome in patients.