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Yamamoto S, Nashi M, Maeda K, Taniike N, Takenobu T. Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report. J Med Case Rep 2022; 16:6. [PMID: 34980242 PMCID: PMC8722306 DOI: 10.1186/s13256-021-03116-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. Case presentation A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient’s mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. Conclusions The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.
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Affiliation(s)
- Shinsuke Yamamoto
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Masanori Nashi
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Keigo Maeda
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Naoki Taniike
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Toshihiko Takenobu
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
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Kim M, Park JK, Lee JY, Kim MJ. Neuromuscular electrical stimulation for a dysphagic stroke patient with cardiac pacemaker using magnet mode change: A case report. World J Clin Cases 2021; 9:5313-5318. [PMID: 34307583 PMCID: PMC8283601 DOI: 10.12998/wjcc.v9.i19.5313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/17/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electromagnetic interference (EMI), means disturbance to the operation of implanted electrical devices caused by external sources. If cardiac pacemaker is implanted into the body, the risk of EMI should be considered when performing neuromuscular electrical stimulation (NMES). So far, no case has been reported that clinical magnets are used to safely manage the EMI risk of patients with cardiac pacemaker in NMES.
CASE SUMMARY A 72-year-old male with swallowing disorder due to pure motor lacunar syndrome was transferred to rehabilitation department six days after the symptom onset. EMI risk needed be considered when implementing NMES on pharyngeal muscles, since cardiac pacemaker was implanted on his left chest due to the sick sinus syndrome. In the first NMES, the function of the pacemaker was directly monitored using telemetric instruments. From the second day, by a simple method of placing a magnet on the pacemaker, we chose to move the pacemaker into a mode that the device was not influenced by external stimulus. This magnet method has been used repeatedly for a year for the safe NMES treatment. We could remove Levin tube four months after the initial symptom and dysphagia related symptoms had not been noted during two-year follow-up period.
CONCLUSION This report is the first case of dysphagia rehabilitation that EMI risk was handled using mode change of pacemaker with magnet. This method is unfamiliar to doctors, but safe and easy approach. This paper could be guidance for clinicians who need to treat patients with EMI risk.
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Affiliation(s)
- Myeongkyu Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul 04763, South Korea
| | - Jin-Kyu Park
- Department of Internal Medicine-Cardiology, Hanyang University College of Medicine, Seoul 04763, South Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul 04763, South Korea
| | - Mi Jung Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul 04763, South Korea
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Nakamura T, Kurosaki S. Effects of Early Dysphagia Rehabilitation by Speech-language-hearing Therapists on Patients with Severe Aspiration Pneumonia. Prog Rehabil Med 2020; 5:20200020. [PMID: 32908953 PMCID: PMC7471375 DOI: 10.2490/prm.20200020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/24/2020] [Indexed: 01/25/2023] Open
Abstract
Objective: To clarify the effect of early dysphagia rehabilitation, early rehabilitation was
started within 2 days of admission by speech-language-hearing therapists in patients
with severe aspiration pneumonia. Methods: The subjects were inpatients with severe aspiration pneumonia (A-DROP≥3) admitted to
our hospital between April 2014 and March 2019. We retrospectively investigated patient
age, sex, A-DROP score, community-acquired or nursing- and healthcare-associated
pneumonia, invasive and noninvasive ventilation, comorbidities, nutritional risk,
admission from nursing home, discharge to nursing home, walking ability before admission
and at discharge, Food Intake LEVEL Scale (FILS) score at the start of rehabilitation
and at discharge, the achievement of oral intake, alternative nutrition in use at
discharge, number of days from admission to the start of rehabilitation, and number of
days from admission to oral intake. We compared the patient characteristics and
rehabilitation outcomes between 159 patients who underwent early dysphagia
rehabilitation and 67 patients who underwent later dysphagia rehabilitation. To assess
the association between alternative nutrition at discharge and early dysphagia
rehabilitation, binominal logistic regression analysis was performed. Results: Early dysphagia rehabilitation was significantly associated with shorter hospital
stays, fewer discharges to nursing homes, higher likelihood of oral intake, the removal
of alternative nutrition at discharge, fewer days from admission to oral intake, and
higher FILS scores at discharge. Early dysphagia rehabilitation was significantly
associated with no alternative nutrition at discharge in binominal logistic regression
analysis (odds ratio 3.26; P <0.01). Conclusions: This study suggested that early dysphagia rehabilitation was effective in improving
outcomes of severe aspiration pneumonia including the removal of alternative nutrition
at discharge.
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Affiliation(s)
- Tomoyuki Nakamura
- Department of Rehabilitation, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shuhei Kurosaki
- Department of Rehabilitation, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
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Duncan S, McAuley DF, Walshe M, McGaughey J, Anand R, Fallis R, Blackwood B. Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis. Intensive Care Med 2020; 46:1326-1338. [PMID: 32514597 PMCID: PMC7334257 DOI: 10.1007/s00134-020-06126-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care. METHODS We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published. RESULTS We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (n = 33, MD (days) - 4.5, 95% CI - 10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or in aspiration following treatment (n = 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n = 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I2 = 15%, P = 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n = 239, MD - 11.38, 95% CI - 23.83 to 1.08, I 2 = 78%, P = 0.07) (very low certainty). CONCLUSION There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.
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Affiliation(s)
- Sallyanne Duncan
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Leinster St. South, Dublin 2, D02 KF66, Ireland
| | - Jennifer McGaughey
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Rohan Anand
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Richard Fallis
- Queen's University Belfast Medical Library, Mullhouse Building, Mullhouse Road, Belfast, BT12 6DP, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
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Yamamoto H, Makigami K, Fukumura N, Ushiyama M. [Is intensive and comprehensive dysphagia rehabilitation effective in preventing hospital-acquired pneumonia in a convalescent rehabilitation ward?]. Nihon Ronen Igakkai Zasshi 2019; 56:516-524. [PMID: 31761858 DOI: 10.3143/geriatrics.56.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To evaluate the effect of intensive and comprehensive dysphagia rehabilitation on the prevention of hospital-acquired pneumonia. PATIENTS AND METHODS In this non-randomized retrospective observational study, we compared two patient groups in a convalescent rehabilitation ward. One included patients after the introduction of an intensive and comprehensive rehabilitative program including various measures, such as nutritional support and respiratory physical therapy (intensive program group); the other included patients who had been admitted before the introduction of the above measures (control group). The primary endpoint was the onset of pneumonia during the hospital stay. A multivariate logistic regression analysis was used to determine the adjusted odds ratio for the relationship between dysphagia rehabilitation and pneumonia onset. RESULTS In the intensive program group, 5 of 291 patients were diagnosed with pneumonia, while in the control group, 13 of 460 were diagnosed with pneumonia. The adjusted odds ratio for intensive and comprehensive dysphagia rehabilitation with respect to hospital-acquired pneumonia was 0.326 (95% confidence interval: 0.112-0.949, p=0.040). CONCLUSION This intensive and comprehensive dysphagia rehabilitation program was thought to be effective in preventing hospital-acquired pneumonia in a convalescent rehabilitation ward.
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Affiliation(s)
| | - Kuniko Makigami
- Department of Rehabilitation, Kenwakai Hospital.,Department of Rehabilitation, Ota Hospital
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Di Pede C, Mantovani ME, Del Felice A, Masiero S. Dysphagia in the elderly: focus on rehabilitation strategies. Aging Clin Exp Res 2016; 28:607-17. [PMID: 26589905 DOI: 10.1007/s40520-015-0481-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 10/17/2015] [Indexed: 11/25/2022]
Abstract
Prevalence of oropharyngeal dysphagia among the elderly is high, but underestimated and underdiagnosed. It may give raise to relevant complications impacting on morbidity, hospital length of stay and health care costs. Dysphagia evaluation and management is a multidisciplinary task; it includes a detailed history taking, clinical and instrumental exams, and identification of the risk of aspiration. Long-standing individual abilities and impairments determine the goals of an ad hoc rehabilitation program. Currently there are no standard algorithmic approaches for the management of dysphagia in the elderly. Education of health professionals on early diagnosis and improvement of therapeutic strategies are mainstays to allow maximal recovery potential in this population. This narrative review summarizes the current rehabilitation approaches for dysphagia in the elderly. The aim is to inform the treating health care professionals, whether caring physician, physical medicine doctor, speech/swallowing therapist or nurse, on the state-of-the-art and stimulate discussion in the scientific community.
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Affiliation(s)
- C Di Pede
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - M E Mantovani
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - A Del Felice
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - S Masiero
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
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