Dysphagia rehabilitation including indirect and direct therapies in post operation of tongue cancer : case report

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  • 舌癌術後の摂食嚥下障害に対し間接訓練ならびに直接訓練を実施した1症例

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Abstract

Post operation of head and neck cancer often leads to dysphagia. We present the case of a 68-year-old man with post operation of tongue cancer. He underwent glossectomy, both sides neck dissection, rectus abdominis muscle flap reconstruction, tracheotomy, and gastrostomy. Physical examination performed at the initial visit revealed a firm neck muscle and failure of oral and pharyngeal transport and velopharyngeal closure due to glossectomy. Videoendoscopy and videofluoroscopy confirmed a safe bolus propulsion (2 cc of thickened liquid) at 60 degrees reclined, left lateral decubitus and right neck rotation position. Indirect and direct therapies were started. Because intraoral pain due to radiation-related oral mucositis was within manageable bounds, he started meal 29 days after the intervention. On the 35th day, he was treated with a palatal augmentation prosthesis (PAP) in order to ameliorate the oral and pharyngeal transport. However, use of PAP did not contribute to any improvement because he could not use it due to incompatibility. We confirmed that he swallowed safely at neck neutral position by videofluoroscopy on the 84th day. We expect that he could recover oral feeding without gastrostomy tube and oral stage with PAP.

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