2008 Volume 12 Issue 1 Pages 61-68
We report the case of a 47-year-old male patient who presented with dysphagia hoarseness, and central-type hypoventilation due to the recurrence of a medullary hemangioblastoma. lnitial treatment included a tracheostomy and the total surgical extirpation of the tumor. As hypoventilation subsided, the tracheostomy was closed, but re-tracheostomy was soon required due to the repeated occurrence of aspiration pneumonia. Videofluorographic examination of the patient's swallowing revealed mis-swallowing due to impairment of the swallowing reflex, resulting from abnormal pharyngeal peristalsis, and failed relaxation of the upper esophageal sphincter (UES). Moreover, no cough reflex was evident, As rehabilitation exercises over a 6 month period demonstrated no significant improvement in either swallowing ability or cough reflex, a total laryngectomy was performed and an indwelling voice prosthesis was placed to prevent continued aspiration pneumonia and preserve phonation. The postoperative course was uneventful, and the subject was able to ingest normally without any need for tube feeding or intravenous alimentation, and could also successfully communicate using the voice prosthesis.
While most operative procedures that prevent mis-swallowing tend to sacrifice phonation, the method reported in this case has the merit of successfully combining the two without compromising either.
