A Case of Dysphagia after the Operation of Descending Necrotizing Mediastinitis

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  • Ito Hiroyuki
    Department of Otolaryngology, Kanagawa Rehabilitation Hospital
  • Kato Takakuni
    Department of Otolaryngology, Jikei University School of Medicine

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Other Title
  • 降下性壊死性縦隔炎術後のえん下障害―特に患者，家族の障害の受容と治療のゴールについて―
  • 症例報告 降下性壊死性縦隔炎術後の嚥下障害--特に患者,家族の障害の受容と治療のゴールについて
  • ショウレイ ホウコク コウカセイ エシセイ ジュウカクエン ジュツゴ ノ エンゲ ショウガイ トクニ カンジャ カゾク ノ ショウガイ ノ ジュヨウ ト チリョウ ノ ゴール ニ ツイテ
  • ―特に患者, 家族の障害の受容と治療のゴールについて―

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Abstract

This paper reports a patient with dysphagia due to descending necrotizing mediastinitis who was compelled to undergo a laryngectomy. The patient was a male aged 61 with diabetes. He experienced pharyngeal pain while eating fish. The next day he consulted an otolaryngologist, but no fish bone was found. Two days after this episode he had cervical swelling that was diagnosed as a cervical abscess. He was underwent a tracheotomy. After undergoing a cervicotomy for cervico-medistinal drainage, he had thracotomy five days after the accident. He subsequently suffered septic shock and cardiac arrest, which resulted in hypoxic brain. His life was saved, but dysphagia and movement disorders of all four limbs due to rigidity remained. A laryngectomy was proposed, but the patient could not accept losing his voice. He was admitted our hospital five months after the onset. A pharyngo-esophagogram demonstrated movement disorders of the hyoid bone and the larynx. Most of the contrast medium was aspirated. The patient and his family rejected a laryngectomy that would result in voice loss. An operation combining of a crycopharyngeal myotomy with a laryngeal elevation under thracheotomy was thought to be efficient, but we were unable to perform the procedure because of the patient's poor general condition and severe cervical soft tissue adhesion. The patient preferred to retain his voice over swallowing and the stoma was closed. After he was discharged our hospital, he had recurrent pneumonia. He finally accepted a laryngectomy in order to prevent death by pneumonia in other hospital. This case suggested us that when we determine treatment of dysphagia, we should take acceptance of disabilities by the patient and his or her family into consideration.

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