Radiation-induced lower cranial nerve palsy in patients with head and neck carcinoma

Bell's palsy after concomitant chemoradiotherapy: a case report and literature review

Concomitant chemoradiotherapy (CCRT) treated patients experience various complications. We present a rare case of post-CCRT Bell's palsy and describe its various possible causes, so as to increase awareness among clinicians about Bell's palsy being a CCRT-associated adverse effect. The patient was a 48-year-old man diagnosed with squamous cell carcinoma who presented with post-CCRT Bell's palsy. After radiotherapy for 6 weeks (overall 67.5 Gy) and four rounds of cisplatin chemotherapy, he complained of paralysis of the entire left face. A test was performed 33 days after the last CCRT session to differentiate Bell's palsy from other causative factors. Based on magnetic resonance imaging findings, facial nerve invasion due to tumor size increase was determined to not cause Bell's palsy. Inflammation of the left Eustachian tube was observed. Hence, steroids and famciclovir were administered, which markedly improved the facial paralysis symptoms within 56 days after facial paralysis development. In conclusion, patients can develop Bell's palsy owing to complex effects of various CCRT mechanisms. Although the exact cause of Bell's palsy has not been identified and the effectiveness of drug treatment was questionable in this case, unlikely causative factors should be excluded through various tests and appropriate and timely measures must be adopted.

Implementing flexible endoscopic evaluation of swallow screening within annual cancer surveillance appointments to monitor for late-stage radiation-induced dysphagia: A feasibility study

BACKGROUND

Late-stage progressive decline of swallowing function after radiotherapy for head and neck cancer (HNC) is often difficult to monitor. This study examined the feasibility and clinical outcomes of speech-language pathology implementing flexible endoscopic evaluation of swallow (FEES) screening during annual cancer surveillance visits to monitor late-stage swallowing function.

METHODS

Patients >2 years post treatment who attended routine oncological visits underwent FEES screening. Feasibility (service data, stakeholder survey) and swallowing outcomes (oral intake, secretions, internal lymphedema, penetration-aspiration, and residue) were collected.

RESULTS

Screening was completed with 70% (50/71) of eligible patients. Medical staff and speech-language pathologists indicated the protocol was worthwhile and achievable to incorporate into practice. Almost all patients were willing to complete the protocol annually. FEES outcomes identified 84% with dysphagia versus only 26% self-reported dysphagia.

CONCLUSION

Findings indicate FEES screening incorporated into annual oncological reviews is feasible and effective at monitoring late-stage swallowing function following HNC.

Ti.: "High" vagus nerve lesions in varicella Zoster infection

“High” vagus nerve lesions are rare and refer to the region of the nerve from the jugular foramen through the branching of the auricular (Arnold's branch) and the pharyngeal branch. Rapid onset of vagus nerve palsy is observed predominantly in trauma, and rarely in inflammation. An insidious onset points to a neoplastic cause.

The acute “high” vagus nerve lesion is characterized by a unilateral paralysis of the recurrent laryngeal nerve, an incomplete paresis of the soft palate and a transient inability to swallow.

This is a case description of a 79-year-old woman who presented with painful swelling of the left ear and occipital headache, followed by inability to swallow for 3 weeks. A markedly elevated Varicella Zoster titer suggested a herpes virus infection.

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Cranial nerve

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Vagus nerve

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High vagus nerve

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acute swallowing disorder

Radiation-induced neuropathies in head and neck cancer: prevention and treatment modalities

Head and neck cancer (HNC) is the sixth most common human malignancy with a global incidence of 650,000 cases per year. Radiotherapy (RT) is commonly used as an effective therapy to treat tumours as a definitive or adjuvant treatment. Despite the substantial advances in RT contouring and dosage delivery, patients suffer from various radiation-induced complications, among which are toxicities to the nervous tissues in the head and neck area. Radiation-mediated neuropathies manifest as a result of increased oxidative stress-mediated apoptosis, neuroinflammation and altered cellular function in the nervous tissues. Eventually, molecular damage results in the formation of fibrotic tissues leading to susceptible loss of function of numerous neuronal substructures. Neuropathic sequelae following irradiation in the head and neck area include sensorineural hearing loss, alterations in taste and smell functions along with brachial plexopathy, and cranial nerves palsies. Numerous management options are available to relieve radiation-associated neurotoxicities notwithstanding treatment alternatives that remain restricted with limited benefits. In the scope of this review, we discuss the use of variable management and therapeutic modalities to palliate common radiation-induced neuropathies in head and neck cancers.

Neuromuscular complications in cancer

Cancer is becoming a treatable and even often curable disease. The neuromuscular system can be affected by direct tumor invasion or metastasis, neuroendocrine, metabolic, dysimmune/inflammatory, infections and toxic as well as paraneoplastic conditions. Due to the nature of cancer treatment, which frequently is based on a DNA damaging mechanism, treatment related toxic side effects are frequent and the correct identification of the causative mechanism is necessary to initiate the proper treatment. The peripheral nervous system is conventionally divided into nerve roots, the proximal nerves and plexus, the peripheral nerves (mono- and polyneuropathies), the site of neuromuscular transmission and muscle. This review is based on the anatomic distribution of the peripheral nervous system, divided into cranial nerves (CN), motor neuron (MND), nerve roots, plexus, peripheral nerve, the neuromuscular junction and muscle. The various etiologies of neuromuscular complications - neoplastic, surgical and mechanic, toxic, metabolic, endocrine, and paraneoplastic/immune - are discussed separately for each part of the peripheral nervous system.