2007 Volume 11 Issue 1 Pages 67-73
A 74-year-old man with severe swallowing disorders due to progressive supranuclear palsy (PSP) was admitted to our hospital. He had not taken food orally for about 4 months after the onset of aspiration pneumonia. Videofluorography (VF) showed impaired tongue motion and closure at the isthmus of fauces due to the soft palate contacting the root of the tongue. This closure made bolus transfer to the pharynx extremely difficult even in the reclined position. Other than delayed onset of the swallowing reflex, there were no other abnormal findings during the pharyngeal stage. A newly designed prosthesis was constructed to help restore soft palate elevation. This prosthesis differs from the palatal lift prosthesis (PLP) in that its function was not intended to correct nasopharyngeal closure, but rather to form a passage for the bolus between the soft palate and root of the tongue. Because it was difficult for the edentulous patient to retain the prosthesis, artificial teeth were fabricated. The prosthesis together with the soft palate dropped down upon mouth opening. Mediated by the artificial teeth, the prosthesis was then raised by the mandibular ridge in order to elevate the soft palate during mouth closing. Use of the prosthesis, placed at a 30-degree reclined position, made it possible for the patient to ingest sliced gelatin jelly. The range in the soft palate elevation was less using this prosthesis compared with that using the PLP, which prevented adverse effects during the pharyngeal stage of swallowing, as demonstrated by VF and patient symptoms. This prosthesis would be particularly beneficial for patients with bolus transfer impairment resulting from closure at the isthmus of the fauces due to soft palate malfunction, while preserving pharyngeal stage function. This newly designed prosthesis may serve a critical role in the treatment of patients with PSP in which this type of soft palatal malfunction is frequently reported.
