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A Case of Post-trauma Dysphagia: Peculiar Swallowing Dynamics Due to Associated Laryngeal Paralysis

BACKGROUND: Associated laryngeal paralysis (ALP) is defined as vagus nerve impairment combined with other lower cranial nerve paralysis. Traumatic ALP is reported infrequently. CASE: A 72-year-old man was injured on the back of the head when a large tree fell on him; he was admitted to a general hos...

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Autores principales: Sugi, Takafumi, Kanazawa, Hideaki, Takinami, Ayano, Kunieda, Kenjiro, Yaguchi, Hiroshi, Sugiyama, Masahiro, Takahashi, Hirotatsu, Fujishima, Ichiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JARM 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365201/
https://www.ncbi.nlm.nih.gov/pubmed/32789271
http://dx.doi.org/10.2490/prm.20200003
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author Sugi, Takafumi
Kanazawa, Hideaki
Takinami, Ayano
Kunieda, Kenjiro
Yaguchi, Hiroshi
Sugiyama, Masahiro
Takahashi, Hirotatsu
Fujishima, Ichiro
author_facet Sugi, Takafumi
Kanazawa, Hideaki
Takinami, Ayano
Kunieda, Kenjiro
Yaguchi, Hiroshi
Sugiyama, Masahiro
Takahashi, Hirotatsu
Fujishima, Ichiro
author_sort Sugi, Takafumi
collection PubMed
description BACKGROUND: Associated laryngeal paralysis (ALP) is defined as vagus nerve impairment combined with other lower cranial nerve paralysis. Traumatic ALP is reported infrequently. CASE: A 72-year-old man was injured on the back of the head when a large tree fell on him; he was admitted to a general hospital, where he was diagnosed with brain concussion and Guillain-Barre syndrome (GBS). The patient developed aspiration pneumonia due to severe dysphagia. Although he underwent treatment and rehabilitation for 6 months, some disabilities persisted, and a percutaneous endoscopic gastrostomy tube was placed. Six months after the accident, the patient was transferred to our rehabilitation hospital. Videoendoscopic examination and videofluoroscopy revealed persistent upper esophageal sphincter (UES) opening, left dominant bilateral IX and X nerve paralysis, and left XII nerve paralysis; moreover, these examinations showed that the swallowing reflex was absent, although a bolus could pass through the UES. We suspected that the patient’s condition was not GBS and performed head computed tomography and magnetic resonance imaging; these revealed a bone fracture at the skull base. Consequently, the patient’s diagnosis was changed to bilateral ALP. He received swallowing rehabilitation for 2 months and could orally consume alternative nutrition. Finally, the patient was able to eat orally texture-modified foods (Food Intake LEVEL Scale level 8). DISCUSSION: While post-trauma dysphagia due to bilateral ALP might be severe, patients can regain the ability to eat orally if clinicians understand the etiology of dysphagia and provide appropriate swallowing rehabilitation techniques, including patient position adjustment while eating and selection of food textures.
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spelling pubmed-73652012020-08-11 A Case of Post-trauma Dysphagia: Peculiar Swallowing Dynamics Due to Associated Laryngeal Paralysis Sugi, Takafumi Kanazawa, Hideaki Takinami, Ayano Kunieda, Kenjiro Yaguchi, Hiroshi Sugiyama, Masahiro Takahashi, Hirotatsu Fujishima, Ichiro Prog Rehabil Med Case Report BACKGROUND: Associated laryngeal paralysis (ALP) is defined as vagus nerve impairment combined with other lower cranial nerve paralysis. Traumatic ALP is reported infrequently. CASE: A 72-year-old man was injured on the back of the head when a large tree fell on him; he was admitted to a general hospital, where he was diagnosed with brain concussion and Guillain-Barre syndrome (GBS). The patient developed aspiration pneumonia due to severe dysphagia. Although he underwent treatment and rehabilitation for 6 months, some disabilities persisted, and a percutaneous endoscopic gastrostomy tube was placed. Six months after the accident, the patient was transferred to our rehabilitation hospital. Videoendoscopic examination and videofluoroscopy revealed persistent upper esophageal sphincter (UES) opening, left dominant bilateral IX and X nerve paralysis, and left XII nerve paralysis; moreover, these examinations showed that the swallowing reflex was absent, although a bolus could pass through the UES. We suspected that the patient’s condition was not GBS and performed head computed tomography and magnetic resonance imaging; these revealed a bone fracture at the skull base. Consequently, the patient’s diagnosis was changed to bilateral ALP. He received swallowing rehabilitation for 2 months and could orally consume alternative nutrition. Finally, the patient was able to eat orally texture-modified foods (Food Intake LEVEL Scale level 8). DISCUSSION: While post-trauma dysphagia due to bilateral ALP might be severe, patients can regain the ability to eat orally if clinicians understand the etiology of dysphagia and provide appropriate swallowing rehabilitation techniques, including patient position adjustment while eating and selection of food textures. JARM 2020-02-22 /pmc/articles/PMC7365201/ /pubmed/32789271 http://dx.doi.org/10.2490/prm.20200003 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
Sugi, Takafumi
Kanazawa, Hideaki
Takinami, Ayano
Kunieda, Kenjiro
Yaguchi, Hiroshi
Sugiyama, Masahiro
Takahashi, Hirotatsu
Fujishima, Ichiro
A Case of Post-trauma Dysphagia: Peculiar Swallowing Dynamics Due to Associated Laryngeal Paralysis
title A Case of Post-trauma Dysphagia: Peculiar Swallowing Dynamics Due to Associated Laryngeal Paralysis
title_full A Case of Post-trauma Dysphagia: Peculiar Swallowing Dynamics Due to Associated Laryngeal Paralysis
title_fullStr A Case of Post-trauma Dysphagia: Peculiar Swallowing Dynamics Due to Associated Laryngeal Paralysis
title_full_unstemmed A Case of Post-trauma Dysphagia: Peculiar Swallowing Dynamics Due to Associated Laryngeal Paralysis
title_short A Case of Post-trauma Dysphagia: Peculiar Swallowing Dynamics Due to Associated Laryngeal Paralysis
title_sort case of post-trauma dysphagia: peculiar swallowing dynamics due to associated laryngeal paralysis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365201/
https://www.ncbi.nlm.nih.gov/pubmed/32789271
http://dx.doi.org/10.2490/prm.20200003
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