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Título

Lower Cranial Nerve Involvement In Patients With Basilar Invagination: a Series of 65 Cases

Resumo

Introduction: Basilar invagination (BI) corresponds to a bony malformation that flattens the skull base over the cervical spine, displacing the odontoid process through the foramen magnum and compressing brainstem, cerebellum, and cervical spinal cord structures. Lesions in this region can imply alterations of the last cranial nerves. Objective: Describe the cranial nerve changes in people who have basilar invagination. Methodology: This is a descriptive, retrospective and quantitative study. The sample was composed of 65 medical records with diagnosis of IB and information regarding the time of pre-surgical evaluation seen between 1996 to 2020. Data were collected with presurgical changes of the last 6 cranial nerves. Results: In 65 medical records, 35 % of cases with reduced sensitivity of the nauseous reflex, 35 % with rhinolalia, 34 % with decreased soft palate reflex, 19 % with soft palate paralysis, 15 % with nasal reflux, 07 % with prognathism and 03 % with retrognathism were evidenced. Dysphagia was also evidenced in 32 % of the cases and dysarthria in 10 % of them. As for other anatomical changes in the craniofacial region, 7 % had hypoglossal nerve damage. Discussion: It was found that 100% of the population studied presented some type of Orofacial and Cervical Myofunctional Disorder (OOFM), showing lesions of the VIII to the XII cranial nerves. The decrease in nausea and soft palate reflexes occurred in a significant number of cases, and in the literature it is one of the most present symptoms both before and after surgery. Nasal reflux impairment, soft palate paralysis, hypotonia, deficit in sensitivity and mobility of the orofacial muscles are also commonly described. Rhinolalia and dysarthria present, are not evidenced in the literature. There was a higher number of disorders related to phonoarticulatory organs (OFA's), and a prevalence of alterations related to dysphagia. Conclusion: The results suggest a relationship between IB and the lower cranial nerves involvement, being the disorders related to the phonoarticulatory organs prevalent. Thus, preoperative evaluation by a speech therapy professional and evaluation of the permanence or not of these alterations in the postoperative period is indicated.

Palavras Chave

Platybasia, Basilar Invagination, Cranial Nerves.