Intra Oral Appliance for Intermittent-Oro-Esophageal Tube Feeding

Abstract

[Purpose]　Intermittent-oro-esophageal tube feeding is an advantageous method, and has been applied in many patients with dysphagia. In this paper, we report a specific intraoral appliance which facilitates intermittent-oro-esophageal tube feeding on a patient with dysphagia in whom several problems made this method difficult.

[Subjects and Methods]　A 72-year-old male with a history of subarachnoid hemorrhage developed cerebral hemorrhage in the subcortex of the left occipital lobe, leading to dysphagia and higher brain dysfunction. The swallowing function was evaluated, and a jelly diet was initiated for training. Finally, 3-times-a-day oral ingestion of a easy swallowing diet was achieved. But, the patient could not take a sufficient volume of water, and so water intake was assisted via intermittent-oro-esophageal tube feeding. However, poor attention due to the higher brain dysfunction resulted in troubles such as tube-biting or extubation during feeding, making it difficult to perform this procedure safely. Therefore, a new intraoral appliance was invented and employed. Intraoral appliance: This appliance is applied in the maxilla, and has the following 2 characteristics: bite at the molar is elevated; and a tunnel-like hole through which the tube is inserted is present on the palate side of the maxillary left molar region. Bite elevation prevents tube-biting at the anterior teeth portion, and facilitates tube insertion into the oral cavity. Tube insertion through the tunnel-like hole is useful for avoiding tube-biting and tube elimination by the tongue and ensuring tube enters to the pharynx.

[Results and Discussion]　Using this intraoral appliance, intermittent-oro-esophageal tube feeding was done safely, in a patient with dysphagia with the risk of tube-biting. This appliance might promote the indication of intermittent-oro-esophageal tube feeding, and improve the quality of life of dysphagia patients.