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Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study

BACKGROUND: Descending necrotizing mediastinitis is a potentially fatal polymicrobial infection that often leads to dysphagia after treatment. Such dysphagia is likely the result of fibrosis and scarring from inflammatory changes in the fascial space. A case is presented in which the mechanism of dy...

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Autores principales: Koyama, Yuji, Isaji, Yuri, Sugimoto, Ayaka, Tochikura, Michi, Kasahara, Takashi, Toyokura, Minoru, Masakado, Yoshihisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JARM 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365184/
https://www.ncbi.nlm.nih.gov/pubmed/32789270
http://dx.doi.org/10.2490/prm.20200002
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author Koyama, Yuji
Isaji, Yuri
Sugimoto, Ayaka
Tochikura, Michi
Kasahara, Takashi
Toyokura, Minoru
Masakado, Yoshihisa
author_facet Koyama, Yuji
Isaji, Yuri
Sugimoto, Ayaka
Tochikura, Michi
Kasahara, Takashi
Toyokura, Minoru
Masakado, Yoshihisa
author_sort Koyama, Yuji
collection PubMed
description BACKGROUND: Descending necrotizing mediastinitis is a potentially fatal polymicrobial infection that often leads to dysphagia after treatment. Such dysphagia is likely the result of fibrosis and scarring from inflammatory changes in the fascial space. A case is presented in which the mechanism of dysphagia was verified using two-dimensional analysis of the muscle lengths of the suprahyoid and infrahyoid muscles. CASE: A 57-year-old woman presented with a hyoid and laryngeal movement disorder with pharyngeal residue secondary to descending necrotizing mediastinitis. To treat this disorder, the chin-down maneuver was performed, and it immediately improved hyoid and laryngeal elevation and reduced pharyngeal residue at the epiglottic valleculae and pyriform sinus. Analysis of the mechanism of these improvements revealed that combined head and neck flexion, compared with neck flexion, decreased the distance between the origin and insertion (DOI) of the sternohyoid muscle (SM) and increased the muscle contraction rate and the maximum contraction duration of the geniohyoid muscle (GM) during swallowing. DISCUSSION: In the present case, the patient had restrictions in extension of the SM that applied resistance to GM contraction. Compensation of this condition was achieved by combined head and neck flexion, which decreased the DOI of the SM, thereby improving the contractile function of the GM.
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spelling pubmed-73651842020-08-11 Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study Koyama, Yuji Isaji, Yuri Sugimoto, Ayaka Tochikura, Michi Kasahara, Takashi Toyokura, Minoru Masakado, Yoshihisa Prog Rehabil Med Case Report BACKGROUND: Descending necrotizing mediastinitis is a potentially fatal polymicrobial infection that often leads to dysphagia after treatment. Such dysphagia is likely the result of fibrosis and scarring from inflammatory changes in the fascial space. A case is presented in which the mechanism of dysphagia was verified using two-dimensional analysis of the muscle lengths of the suprahyoid and infrahyoid muscles. CASE: A 57-year-old woman presented with a hyoid and laryngeal movement disorder with pharyngeal residue secondary to descending necrotizing mediastinitis. To treat this disorder, the chin-down maneuver was performed, and it immediately improved hyoid and laryngeal elevation and reduced pharyngeal residue at the epiglottic valleculae and pyriform sinus. Analysis of the mechanism of these improvements revealed that combined head and neck flexion, compared with neck flexion, decreased the distance between the origin and insertion (DOI) of the sternohyoid muscle (SM) and increased the muscle contraction rate and the maximum contraction duration of the geniohyoid muscle (GM) during swallowing. DISCUSSION: In the present case, the patient had restrictions in extension of the SM that applied resistance to GM contraction. Compensation of this condition was achieved by combined head and neck flexion, which decreased the DOI of the SM, thereby improving the contractile function of the GM. JARM 2020-02-20 /pmc/articles/PMC7365184/ /pubmed/32789270 http://dx.doi.org/10.2490/prm.20200002 Text en ©2020 The Japanese Association of Rehabilitation Medicine http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) 4.0 License.
spellingShingle Case Report
Koyama, Yuji
Isaji, Yuri
Sugimoto, Ayaka
Tochikura, Michi
Kasahara, Takashi
Toyokura, Minoru
Masakado, Yoshihisa
Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study
title Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study
title_full Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study
title_fullStr Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study
title_full_unstemmed Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study
title_short Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study
title_sort successful treatment with the chin-down maneuver of dysphagia secondary to descending necrotizing mediastinitis: a case study
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365184/
https://www.ncbi.nlm.nih.gov/pubmed/32789270
http://dx.doi.org/10.2490/prm.20200002
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