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Objective:To summarize the combined rehabilitation nursing process of a case of voice and deglutition disorders following surgical removal of intra-and extracranial schwannoma in the jugular foramen area.Methods:A case of hoarseness and dysphagia after surgery for intracranial and extracranial schwannomas in the left jugular foramen region in Xuanwu Hospital, Capital Medical University in October 2020 was collected. Early step-wise voice training assisted by respiratory muscles and tongue muscle exercises was carried out, electronic laryngoscope-based breathing and swallowing methods, assessment of food and bite-size, maintenance of food consistency with the assistance of chewing times, and swallowing and ingestion guidance for the update of dietary methods were performed. The continuous rehabilitation training was provided throughout the process.Results:The grade of GRBAS scale decreased from G3 to G2 after training from home for 3 months following discharge; the voice handicap index of Chinese version reduced from 75 points to 52 points, and the average pronunciation time extended from 2.45 s to 5.32 s. The frequency of choking with food optimized from 0.4 to 0.5 times/min to no choking.Conclusions:Early rehabilitation training of voice and, swallowing and ingestion is a boon for the recovery of hoarseness and dysphagia after resection of schwannomas in the jugular foramen region.
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Objective To comparatively study the displacement of surrounding structures of jugular foramen (JF) via far lateral approach under middle cranial flexion supine and oblique supine,and to provide the anatomical basis for the protection of these relative structures during choosing regional surgical approaches.Methods Forty-one healthy adults were scanned by PHILIPS Brilliance 64-slice CT according to the conditions:1 mm thick bone window under the middle cranial flexion supine position and oblique supine positions,continuous axial scanning,and being ranged from horizontal canal to C3 levels bony landmarks.The scanned images were inputted Philips Extended Brilliance Workspace CT reconstruction of multi-plane (MPR) and the data were measured.Results In the middle cranial flexion supine position,the distances from transverse process atlas to the ipsilateral mastoid tip,tip of the styloid process,the midpoint of the outer edge in occipital condyle were (20.99±4.18) mm,(20.49±5.47) mm,and (22.035±4.27) mm.In the supine oblique position,the distances from transverse process atlasto the ipsilateral mastoid tip,tip of the styloid process,the midpoint of the outer edge in occipital condyle were (22.795±3.29) mm,(22.315±5.48) mm and (23.025±3.91) mm.Significant differences were noted in these three distances between the two positions (P＜0.05).Conclusion In the JF surgical approach,supine oblique can change the relative spatial relationship of correlative structures,increase the exposure of the jugular vein area,therefore,protect the facial nerve,vertebral artery and posterior extracranial structures,and reduce the damage to surrounding structural tissues and the complications.
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By means of a planimeter and skulls adjusted in the eye-ear plane, measurements of areas of the foramen ovale, spinosum, lacerum, jugulae and orifice of the canalis caroticus on both sides of the external surface of the skull base have been taken on 100 adult skulls collected in Chengdu. The symmetry of these areas has been studied. The main results of the study are given below: 1. In 4% of the whole series, the area of the foramen ovale is approximately equal on the two sides and the difference in area between the two sides is less than 1%. In 44%, the right side is larger, and in 52%, the left is larger. 2. In 5% of the whole series, the area of the foramen spinosum is approximately equal on the two sides. In 42%, the right side is larger, and in 53%, the left is larger. 3. In 4% of the whole series, the area of the foramen lacerum is approximately equal on the two sides. In 46%, the right side is larger, and in 50%, the left is larger. 4. In 3% of the whole series, the area of the foramen jugulae is approximately equal on the two sides. In 76%, the right side is larger, and in 21%, the left is larger. 5. In 3% of the whole series, the area of the anterior part of the foramen jugulae is approximately equal on the two sides. In 50%, the right side is larger, and in 47%, the left is larger. 6. In 17% of the whole series, the area of the intermediate part of the foramen jugulae is approximately equal on the two sides. In 37%, the right side is larger, and in 46%, the left is larger. 7. In 2% of the whole series, the area of the posterior part of the foramen jugulae is approximately equal on the two sides. In 79%, the right side is larger, and in 19%, the left is larger. 8. In 5% of the whole series, the area of the orifice of the canalis caroticus is approximately equal on the two sides. In 58%, the right side is larger, and in 37%, the left is larger. Moreover, a quantitative analysis of the bilateral areas has been carried out. The foramen area is highly positive in correlation With the product of its length and width. Therefore, the regression formulas of the areas are as follows: The foramen ovale-right, ■=1.5129+0.6699x (r=0.9417); left, ■=0.3695+0.6876x(r=0.8949). The foramen spinosum-right, ■=0.7827+0.6089x (r=0.8755); left, ■=0.3499+0.6695x (r=0.9207). The foramen lacerum-right, ■=9.4190+0.4480x (r=0.9147); left, ■=13.5198+0.4082x (r=0.8493). The foramen jugulaeright, ■=18.3913+0.5092x (r=0.8843); left,■=11.3561+0.5744x (r=0.9193). The anterior part of the foramen jugulae-right, Y=3.3141+0.4858x (r=0.8330); left, ■=3.2294+0.4854x (r=0.8452) The intermediate part of the foramen jugulae-right, ■=2.5434+0.4311x (r=0.7942); left, Y=1.7547+0.5227x (r=0.8366). The posterior part of the foramen jugulae-right,■=1.3470+0.6311x (r=0.8273); left, ■=0.9110+0.6586x (r=0.9480). The orifice of the canalis caroticus-right, ■=1.0986+0.6794x (r=0.9128); left, ■=1.5038+0.6590x (r=0.9219). (x is the product of the length and width of its foramen).