Table 7. Intraoperative and postoperative techniques that may decrease the incidence and/or severity of oropharyngeal dysphagia after ACSS.

Use preoperative tracheal/esophageal traction exercise57

Improve surgical techniques or make changes in perioperative management30

Place retractor blades cautiously under the longus colli muscles39

Release the endotracheal tube cuff and reinflate it after retractor placement to minimize pressure-related damage to the RLN58 59

Decrease endotracheal tube cuff pressure to 20 mm Hg to improve patient comfort following ACSS51

Limit operative time to < 175 min

Use smaller and smoother plates27; use low-profile plates (keep the cervical plate flush against the anterior vertebral surface by burring down the preoperative osteophytes, contouring lordosis into the plate to avoid plate prominence > 7 mm, and using larger incisions for easy visualization)13

Utilize a team approach during surgery: head and neck surgeon providing the exposure and neurosurgeon performing the procedures42

Ensure knowledge of normal and aberrant courses of the SLN and RLN42

Use low-dose oral steroids (methylprednisolone) perioperatively in selected patients to minimize neck/airway swelling and dysphagia in the acute period1 20 24

Use a retropharyngeal local steroid (triamcinolone 40 mg) to control local inflammatory response thus reduce PSTS and airway swelling20

Involve speech pathologists and otolaryngologists in the postsurgery evaluation, especially in cases of high risk19 25 39

Introduce laryngeal diagnostic techniques and voice management early42

Abbreviations: ACSS, anterior cervical spine surgery; PSTS, prevertebral soft tissue swelling; RLN, recurrent laryngeal nerve; SLN, superior laryngeal nerve.