Abstract
A 46-year-old male presented with dysphagia caused by a subarachnoid hemorrhage. He developed nocturnal central apnea, left limb ataxia, and severe hoarseness due to left vocal fold paralysis. He also experienced severe dysphagia due to bulbar palsy. A videofluoroscopic examination (VF) of swallowing showed an impairment of the upper esophageal sphincter opening. Consequently, balloon dilatation for cricopharyngeal dysfunction was performed. The dysphagia did not improve, although the balloon dilatation was continued for 2 months. To prevent the aspiration of food and saliva, a cricopharyngeal myotomy, laryngeal suspension, laryngeal framework surgery (left arytenoid adduction and type I thyroplasty), and cricothyroid disarticulation were performed. A postoperative VF revealed that the entrance of the esophagus opened with a forward motion of the neck and the food bolus passed successfully into the esophagus by means of gravity. The aspiration of food and saliva no longer occurred and the patient was able to eat three times a day without tube feeding. In addition, his voice quality also markedly improved after the operation.
