Sung An, Lee Ka-Wo
Department of Otolaryngology-Head and Neck Surgery, Pingtung Hospital of Ministry of Health and Welfare, Zi-You Road #270, Pingtung City, 90054, Taiwan.
Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
BMC Surg. 2020 Jan 8;20(1):6. doi: 10.1186/s12893-019-0667-5.
Head and neck surgeries can perturb normal structures of neck muscles and nerve innervations, which are supposed to function in harmony to allow complicated process like swallowing. It is still likely that cricopharyngal dysfunction emerges years after the head and neck surgeries.
We report a case with history of left unilateral vocal cord immobility and development of dysphagia and aspiration 2 years after radical thyroidectomy with neck lymph nodes dissection and medialization thyroplasty. Cricopharyngeal dysfunction was impressed and was confirmed with visualization of cricopharyngeal narrowing segment in radiographic contrast swallow examination. The patient was treated successfully by cricopharyngeal myotomy, achieving long-term relief in our 4 years of follow up.
Our case of delayed cricopharyngal dysfunction after radical thyroidectomy and medialization thyroplasty shows that it is important to follow up swallowing functions after patients with UVCI undergo medialization thyroplasty. In the event of delayed manifestation of cricopharyngeal function, it can still be treated successfully by cricoharyngeal myotomy, achieving long term relief of dysphagia.
头颈外科手术可能会扰乱颈部肌肉的正常结构和神经支配,而这些结构本应协同发挥作用,以实现吞咽等复杂过程。头颈外科手术后数年仍有可能出现环咽肌功能障碍。
我们报告一例患者,有左侧单侧声带麻痹病史,在接受根治性甲状腺切除术、颈部淋巴结清扫术和甲状软骨成形术2年后出现吞咽困难和误吸。诊断为环咽肌功能障碍,并在放射造影吞咽检查中通过观察到环咽肌狭窄段得以证实。该患者通过环咽肌肌切开术成功治愈,在我们4年的随访中实现了长期缓解。
我们的病例显示,在接受甲状软骨成形术的单侧声带麻痹患者中,术后随访吞咽功能很重要。如果出现环咽肌功能延迟表现,仍可通过环咽肌肌切开术成功治疗,实现吞咽困难的长期缓解。