Oshima Fumiko
Department of Neurology, Japanese Red Cross Kyoto Daiichi Hospital.
Rinsho Shinkeigaku. 2011 Nov;51(11):1069-71. doi: 10.5692/clinicalneurol.51.1069.
Dysphagia after lateral medullary infarction (LMI) is common. The dysphagia of LMI is dynamically characterized by a failure in triggering of the pharyngeal-phase swallowing movements, reduced output, and lack of coordination (swallowing pattern abnormality). Based on accurate evaluation, we can select suitable rehabilitative approaches for individual patients, including respiratory therapy, food modification, postural changes, and oral care. We focused on the absence of upper esophageal sphincter (UES) opening of the unaffected side of the medullae. The movement pattern was defined as failure of bolus passage through the intact side of the UES, occurring at least once during the videofluorographic evaluation of each individual. Three abnormal patterns of UES opening were classified. The passage pattern abnormality shows the failure of the stereotyped motor sequence. For severe cases, it is necessary to consider long-term treatment, including botulinum toxin injection or surgery to prevent aspiration and adequate nutritional management.
延髓外侧梗死（LMI）后吞咽困难很常见。LMI导致的吞咽困难动态特征表现为咽期吞咽运动触发失败、输出减少以及缺乏协调性（吞咽模式异常）。基于准确评估，我们可以为个体患者选择合适的康复方法，包括呼吸治疗、食物调整、体位改变和口腔护理。我们关注延髓未受影响侧的食管上括约肌（UES）未开放情况。运动模式定义为在对每个个体进行视频荧光造影评估期间，至少有一次出现食团通过完整侧UES失败的情况。UES开放存在三种异常模式。通过模式异常表现为定型运动序列失败。对于严重病例，有必要考虑长期治疗，包括注射肉毒杆菌毒素或手术以防止误吸以及进行适当的营养管理。
