Togashi Takafumi, Baba Hironori, Kitazawa Meiko, Takahashi Nao, Samejima Yasuhiro, Yumoto Eiji, Horii Arata
Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Auris Nasus Larynx. 2018 Oct;45(5):1093-1097. doi: 10.1016/j.anl.2017.12.004. Epub 2018 Feb 1.
Cluster of acute flaccid paralysis and cranial nerve dysfunction was associated with a 2014 outbreak of enterovirus D68 (EV-D68) respiratory illness in US. We describe a 33 year-old male patient of refractory dysphagia due to EV-D68-induced brainstem encephalitis successfully treated by surgery. Following acute upper respiratory tract infection, he developed dysphagia and bilateral facial paralysis. A coughing reflex was readily produced when the laryngopharyngeal fiberscope touched the epiglottis, however, water infusion induced only very weak and slow swallowing reflex, suggesting that only motor component was impaired but sensory function was preserved during swallowing. Despite eight months-conservative rehabilitations, Food Intake Level Scale (FILS) remained level 4. Therefore, corrective surgeries including cricopharyngeal myotomy, laryngeal suspension, and pharyngeal flap were performed. Thirty-six days after surgery, FILS rapidly and dramatically improved to level 8. This is the first report describing a successful surgical intervention for EV-D68-induced refractory dysphagia. Surgical treatment was suitable for EV-D68-induced dysphagia, perhaps because sensory function was preserved and only motor disturbance was present during the pharyngeal stage of swallowing.
急性弛缓性麻痹和颅神经功能障碍聚集性病例与2014年美国肠道病毒D68（EV-D68）引起的呼吸道疾病暴发有关。我们描述了一名33岁男性患者，因EV-D68诱发的脑干脑炎导致难治性吞咽困难，经手术成功治疗。急性上呼吸道感染后，他出现吞咽困难和双侧面部麻痹。当咽喉纤维镜接触会厌时，容易引发咳嗽反射，然而，注水仅诱发非常微弱且缓慢的吞咽反射，这表明吞咽过程中仅运动成分受损，感觉功能得以保留。尽管进行了八个月的保守康复治疗，食物摄入水平量表（FILS）仍为4级。因此，实施了包括环咽肌切开术、喉悬吊术和咽瓣手术在内的矫正手术。术后36天，FILS迅速显著改善至8级。这是第一份描述对EV-D68诱发的难治性吞咽困难进行成功手术干预的报告。手术治疗适用于EV-D68诱发的吞咽困难，可能是因为吞咽咽部阶段感觉功能得以保留，仅存在运动障碍。
