Traction Training with Lip Strap to Improve Mouth Closing Ability and Dysphagia: A Case Report

<p>Introduction:　We report a case of marked inability to close the mouth and dysphagia. A devised mouthclosing exercise improved this patient’s open-mouth state and enabled oral ingestion.</p><p>Patient:　An 85-year-old man with aspiration pneumonitis and dehydration was admitted to a local hospital at the end of July 201X. Although oral ingestion was resumed, he remained unable to close his mouth and had difficulty swallowing. Therefore, he was transferred to our hospital in August for swallowing training.</p><p>Clinical Course:　His inability to close his mouth was evaluated with CT scans, but neither TMJ luxation nor bone fracture was detected. Paralysis of masticatory muscles was suspected. A speech therapist performed mandibular range of motion and muscle-strengthening exercises, but his open-mouth state did not improve. Furthermore, his systolic blood pressure often exceeded 180 mmHg. In traction training with a chin cap, the rubber bands attached to the retractor were too weak to fully elevate his mandible. Thus, we switched to another kind of traction training, with a TMJ brace (brand name Lip Strap). During direct therapy with the Lip Strap, he could keep his mouth closed and swallow a small amount. However, without the Lip Strap, his mouth stayed open and he had trouble swallowing. Continuous traction training allowed him to keep his mouth closed without the Lip Strap on and to ingest a full dosage of pureed food (1,600 kcal/day). He was discharged on the 78th day of hospitalization and returned to the previous hospital.</p><p>Discussion:　A head MRI revealed abnormalities in the responsible lesion in the masticatory muscles and significant hypotonia of the masticatory muscles, mainly in bilateral masseter. We therefore considered his disturbance to be masticatory paralysis caused by trigeminal paralysis. When wearing the Lip Strap at the initiation of direct therapy, mandibular elevation was supplemented, which allowed him to swallow with his mouth closed. VF revealed that decreased oral cavity volume led to tongue-palate contact. This contact improved delivery of the alimentary bolus to the pharynx and facilitated swallowing. In traction therapy, continuous traction is used for dystonia caused by central nervous system disorder. The Lip Strap’s chin strap maintained a constant fixing force and achieved continuous traction over several hours. These findings suggest that continuous traction with the Lip Strap stimulated masticatory muscle contraction, achieving a closed-mouth state.</p>