Improvement of remained swallowing disorder due to a deep neck abscess by adequate rehabilitation:case report

【はじめに】今回我々は深頸部膿瘍により嚥下障害が残存したが,適切なリハビリテーションを行うことで経口摂取が可能となった一例を経験したのでここに報告する.【症例】68歳男性.食欲不振と胸部痛を主訴に救急外来受診した.右中咽頭から下咽頭にかけての深頸部膿瘍と診断.約4ヵ月の前医入院加療後,残存した嚥下障害に対するリハビリ目的で産業医科大学リハビリテーション科紹介となる.【経過】嚥下造影では舌骨の動きが悪く,右梨状窩の食物の残留を認めた.舌骨の挙上不良に対しては間接訓練,咽頭残留に対しては咽頭残留除去法の指導を行った.約1ヵ月後の嚥下造影では,舌骨の挙上不良と咽頭残留は共に改善傾向を示した.【考察】深頸部感染症後に嚥下障害が生じる理由として,高度な炎症の治療後に瘢痕形成をきたし喉頭の挙上制限が生じたためと考えられた.深頚部感染症の治療後に嚥下障害を生じた場合にも適切な評価,その結果に応じた訓練や摂食指導を行うことが重要である.

【Background】 We present a case in which remained swallowing dysfunction improved by adequate rehabilitation after treatment of a deep neck abscess.【Case presentation】 A 68-year-old male presented to the emergency department of our hospital with appetite loss and chest pain and was diagnosed as having a deep neck abscess. While antibiotic treatment was effective, swallowing disorder became apparent after treatment. Thus, he was referred to our department for rehabilitation.【Clinical course】 Videofluoroscopic(VF)examination of swallowing function revealed decreased hyoid movement and pharyngeal residue in the right piriform recess. Indirect therapy to treat the upward movement disorder of the hyoid and training to clear the pharyngeal residue were started. One month later, repeated VF showed improved hyoid movement and decreased residue in the piriform recess.【Discussion】 The main cause of swallowing disorder of this patient was considered to be the limited upward movement of the pharynx due to severe cicatrix formation after massive inflammation. When swallowing dysfunction appears after development of a deep neck abscess, adequate therapy and/or training based on detailed evaluation is necessary.

深頸部膿瘍

嚥下障害

リハビリテーション