抄録
Introduction: A patient with severe dysphagia following cerebellar and brain stem infarction was able to achieve a complete return to oral intake with direct and indirect swallowing therapy, use of a prosthetic appliance for swallowing disorder, and botulinum toxin （BOTOX） injection in the cricopharyngeal muscle. Case report: The patient was a man in his 60s with a chief complaint of being unable to swallow despite wanting to eat after right cerebellar and brain stem infarction. Course: He began attending the rehabilitation unit at our institution 1 year and 2 months after the infarction. Initial videofluorography revealed weak elevation of the back of the tongue and regurgitation of the food bolus from the pharynx into the oral cavity. Use of a custom-made palatal augmentation prosthesis （PAP） improved food transfer to the pharynx; however, insufficient opening of the upper esophageal sphincter resulted in difficulty in swallowing. BOTOX was injected into the cricopharyngeal muscle and upper esophageal sphincter opening improved. However, he was unable to develop an effective swallowing pattern and regurgitation of the food bolus into the nasal cavity was still observed. Construction of a palatal lift prosthesis （PLP） to extend the PAP reduced regurgitation into the nasal cavity. Results: Oral intake was achieved about 2 years post-infarction due to swallowing therapy, use of PAP and PLP, and BOTOX injection for severe eating impairment and dysphagia.
