輪状咽頭筋ミオパチーにサルコペニアを伴った嚥下障害例

抄録

Dysphagia in older persons can be of diverse causation. Herein, we report the case of a 74-year-old man with severe dysphagia caused by myopathy of the cricopharyngeal muscle.

His swallowing function had begun to deteriorate 6 years before his first visit to our hospital. Videoendoscopic and video-fluorographic examinations of swallowing revealed no dilatation of the esophageal orifice. The patient was treated by cricopharyngeal myotomy. Histopathologic examination revealed myopathy of the cricopharyngeal muscle. However, no improvement of the swallowing function was observed after the surgery. This finding, along with his weight loss of 10 kg during the 6-year period suggested that the patient had sarcopenia with a loss of general muscle strength, including of the muscles related to swallowing, due to malnutrition. After nutritional management by tube feeding and swallowing rehabilitation for 3 months, he showed improvement in the swallowing function, and finally resumed oral intake. Indeed, video-fluorography after 5 months of rehabilitation revealed that the anterior movement distance of the hyoid had increased. This result indicated that anterior movement of the hyoid plays an important role in the dilatation of the esophageal orifice during swallowing.