Abstract
We report two cases of dysphagia with different pathophysiologies. In Case 1, dysphagia occurred after anterior cervical spine surgery for a C5-level spinal cord injury. The symptom of difficulty in swallowing saliva was recognized ∼40 days postoperatively at the time of ventilator weaning. Dysphagia persisted even after weaning from ventilator (hospital day 56) and oxygen (hospital day 67). In Case 2, cervical necrotizing fasciitis and descending necrotizing mediastinitis were treated by transcutaneous catheter drainage. After drainage for ∼50 days, tracheostomy was performed. Dysphagia was found at the time of ventilator weaning. In both cases, dysphagia remained despite changing the tracheal tube. VFs were performed in a time series to assess the mechanism and degree of dysphagia. Bedside swallowing training was continued daily and the tracheal tube selection was considered. The dysphagia duration was ∼125 days in Case 1 and ∼150 days in Case 2. The dysphagia recovery period after changing to a cuffless tube was ∼45 days and ∼17 days, respectively. Dysphagia is not an urgent symptom, and may not be taken into consideration during emergency and critical care. In tracheostomy patients, appropriate tube selection should be carefully considered to shorten the placement duration, and swallowing function should be evaluated without delay by VFs if dysphagia persists.
