用于治疗与脑出血、舌缺损和肌肉减少症相关的吞咽困难的声门闭合手术：一例报告
Glottal Closure Surgery for Dysphagia Associated with Cerebral Hemorrhage, Tongue Defect, and Sarcopenia: A Case Report.
作者信息
Kishima Masako, Wakabayashi Hidetaka, Kanazawa Hideaki, Itoda Masataka, Nishikimi Toshio, Kishima Masako, Wakabayashi Hidetaka, Kanazawa Hideaki, Itoda Masataka, Nishikimi Toshio
机构信息
Department of Dentistry, Wakakusa-Tatsuma Rehabilitation Hospital, Osaka, Japan.
Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan.
出版信息
Prog Rehabil Med. 2018 Dec 11;3:20180020. doi: 10.2490/prm.20180020. eCollection 2018.
BACKGROUND
Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure.
CASE
At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient's Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient's nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient's FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge.
DISCUSSION
Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.
BACKGROUND
Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure.
CASE
At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient's Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient's nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient's FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge.
DISCUSSION
Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.
背景
吞咽困难在口腔癌手术后经常出现。然而，尚未有吞咽困难合并脑出血、舌缺损和肌肉减少症的病例报道。我们描述了一名70岁男性患者的病例，该患者因脑出血、舌缺损和肌肉减少症而出现吞咽困难，接受了康复营养治疗并进行了声门闭合术。
病例
患者48岁时因癌症切除了左侧部分舌头。22年后，他在脑出血后出现吞咽困难和右侧偏瘫。根据左手握力低（10 kg）和小腿围减小（26.5 cm），患者被诊断为肌肉减少症。患者的功能性口服摄入量量表（FOIS）评分为1，其舌肌质量显示萎缩，使得最大舌压难以测量。制作了腭部增高假体（PAP）以增加吞咽和舌压，并将营养摄入从鼻饲改为胃造瘘。营养摄入量增加到2400 kcal/天，蛋白质摄入量增加到96 g/天。尽管使用PAP的康复营养改善了患者的营养状况，但吞咽困难并未改善，因此他接受了声门闭合术。这导致体重增加了13.7 kg，舌肌力量和体积增加。出院5个月后，患者的FOIS评分提高到7分（即无限制的全口服饮食）。
讨论
声门闭合手术可能有助于改善经口摄入、营养状况和日常生活活动能力。
背景
吞咽困难在口腔癌手术后经常出现。然而，尚未有吞咽困难合并脑出血、舌缺损和肌肉减少症的病例报道。我们描述了一名70岁男性患者的病例，该患者因脑出血、舌缺损和肌肉减少症而出现吞咽困难，接受了康复营养治疗并进行了声门闭合术。
病例
患者48岁时因癌症切除了左侧部分舌头。22年后，他在脑出血后出现吞咽困难和右侧偏瘫。根据左手握力低（10 kg）和小腿围减小（26.5 cm），患者被诊断为肌肉减少症。患者的功能性口服摄入量量表（FOIS）评分为1，其舌肌质量显示萎缩，使得最大舌压难以测量。制作了腭部增高假体（PAP）以增加吞咽和舌压，并将营养摄入从鼻饲改为胃造瘘。营养摄入量增加到2400 kcal/天，蛋白质摄入量增加到96 g/天。尽管使用PAP的康复营养改善了患者的营养状况，但吞咽困难并未改善，因此他接受了声门闭合术。这导致体重增加了13.7 kg，舌肌力量和体积增加。出院5个月后，患者的FOIS评分提高到7分（即无限制的全口服饮食）。
讨论
声门闭合手术可能有助于改善经口摄入、营养状况和日常生活活动能力。
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