Liu Lirong, Huang Shujuan, Chen Hanbo, Chen Si, Liang Jinfeng, Liu Churong
Department of Rehabilitation, Guang Dong Sanjiu Brain Hospital, Guangzhou, Guangdong Province, China.
Medicine (Baltimore). 2025 Jul 25;104(30):e43525. doi: 10.1097/MD.0000000000043525.
Post-traumatic dysphagia is a severe complication of traumatic brain injury, particularly in cases involving medullary damage. The rare combination of cricopharyngeal achalasia and bilateral vocal cord paralysis presents substantial challenges, with profound swallowing dysfunction and increased aspiration risk. Current treatments primarily target cricopharyngeal dysfunction but lack effective solutions for concurrent vocal cord paralysis, highlighting the need for innovative therapeutic strategies.
A 15-year-old male presented with severe dysphagia, confirmed as upper esophageal sphincter (UES) dysfunction and bilateral vocal cord paralysis. The patient exhibited severe aspiration (grade V water swallowing test, penetration aspiration scale: score of 7) and elevated UES residual pressure (28.2 mm Hg, normal < 12.0 mm Hg).
Post-traumatic neurogenic dysphagia with cricopharyngeal achalasia and bilateral vocal cord paralysis secondary to medullary damage.
An individualized protocol combining vagus nerve magnetic stimulation (VNMS) and conventional rehabilitation was implemented. VNMS targeted the left vagus nerve using 5 Hz stimulation at 80% resting motor threshold, while rehabilitation included pulmonary exercises, balloon dilation therapy, and tongue base pressure training.
Substantial improvements were observed. UES residual pressure decreased from 28.2 mm Hg to 2.7 mm Hg, penetration aspiration scale score improved from 7 to 2, and the functional oral intake scale increased from level 1 to level 6, enabling oral feeding and removal of the tracheostomy and gastric tube. No adverse events were reported.
This case highlights the potential of VNMS as a noninvasive and effective treatment for complex post-traumatic brain injury dysphagia involving cricopharyngeal achalasia and bilateral vocal cord paralysis. By addressing dual swallowing-related pathologies, VNMS offers a promising therapeutic approach in neurorehabilitation. Further research is warranted to validate these findings and explore broader clinical applications.
创伤后吞咽困难是创伤性脑损伤的一种严重并发症，尤其是在涉及延髓损伤的病例中。环咽肌失弛缓症与双侧声带麻痹的罕见组合带来了巨大挑战，导致严重的吞咽功能障碍和误吸风险增加。目前的治疗主要针对环咽肌功能障碍，但对于同时存在的声带麻痹缺乏有效的解决方案，这凸显了创新治疗策略的必要性。
一名15岁男性出现严重吞咽困难，经确诊为食管上括约肌（UES）功能障碍和双侧声带麻痹。患者表现出严重的误吸（V级饮水试验，渗透误吸量表评分：7分）以及UES残余压力升高（28.2毫米汞柱，正常<12.0毫米汞柱）。
创伤后神经源性吞咽困难，伴有环咽肌失弛缓症和继发于延髓损伤的双侧声带麻痹。
实施了一项将迷走神经磁刺激（VNMS）与传统康复相结合的个性化方案。VNMS以80%静息运动阈值采用5赫兹刺激靶向左侧迷走神经，而康复治疗包括肺部锻炼、球囊扩张治疗和舌根压力训练。
观察到显著改善。UES残余压力从28.2毫米汞柱降至2.7毫米汞柱，渗透误吸量表评分从7分提高到2分，功能性经口摄食量表从1级提高到6级，能够经口进食并拔除气管造口管和胃管。未报告不良事件。
本病例突出了VNMS作为一种非侵入性且有效的治疗方法，用于治疗涉及环咽肌失弛缓症和双侧声带麻痹的复杂创伤后脑损伤吞咽困难的潜力。通过解决与吞咽相关的双重病理问题，VNMS在神经康复中提供了一种有前景的治疗方法。有必要进行进一步研究以验证这些发现并探索更广泛的临床应用。
