Fujiwara Kazunori, Koyama Satoshi, Fukuhara Takahiro, Takeuchi Hiromi
Division of Otolaryngology, Head and Neck Surgery, Department of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Yonago Acta Med. 2019 Jul 20;62(3):253-257. doi: 10.33160/yam.2019.09.002. eCollection 2019 Sep.
Descending necrotizing mediastinitis (DNM) is a life-threatening disease with a high fatality rate that occurs as a complication of deep neck abscess. DNM complicated by severe dysphagia during the postoperative period has been previously reported, but there have been no published cases of surgical treatment for severe dysphagia secondary to DNM. A 63-year-old man was diagnosed with a deep neck abscess followed by DNM. The patient had dysphagia after incision and drainage of the abscess and drainage for DNM with video-assisted thoracic surgery (VATS). A comprehensive long-term physiotherapy program with a speech and language therapist did not reduce his dysphagia. Thus, the patient underwent laryngeal elevation and cricopharyngeal myotomy, which enabled oral intake. Surgery should be considered for prolonged severe restriction of laryngeal elevation and esophageal introitus opening that is unresponsive to physiotherapy with a speech and language therapist.
下行性坏死性纵隔炎（DNM）是一种由深部颈部脓肿引发的、死亡率很高的危及生命的疾病。先前已有关于术后并发严重吞咽困难的DNM的报道，但尚无关于DNM继发严重吞咽困难的手术治疗的公开病例。一名63岁男性被诊断为深部颈部脓肿，随后发展为DNM。患者在脓肿切开引流及通过电视辅助胸腔镜手术（VATS）进行DNM引流后出现吞咽困难。由言语和语言治疗师进行的全面长期物理治疗方案并未减轻其吞咽困难。因此，该患者接受了喉提升术和环咽肌切开术，从而能够经口进食。对于经言语和语言治疗师进行物理治疗无效的长期严重喉提升受限和食管入口开放受限，应考虑手术治疗。
