Abstract
Case: A 54-year-old man presented with left Horner syndrome, left facial paralysis, lateropulsion toward the left side, bulbar palsy, and sensory disturbance in the right face and left limb/body. He was diagnosed with left lateral medullary infarction by brain MR imaging. Dysphagia was so severe that oral intake was prohibited at the time of admission. Upon laryngoscopic examination, there was a large amount of saliva pooling in the pyriform sinus, but the vocal cords were not paralyzed. There was a large amount of residue in the left pyriform sinus after deglutition.
In videofluoroscopy, the dominant side for bolus transport to the hypopharynx was the left and that for bolus passage at the cricopharyngeal portion was the right. Swallowing with head rotation toward the nonresidual side was attempted to clear the left residue, but it was not effective. On the other hand, swallowing with head rotation toward the food residual side was effective for clearance of the left pyriform sinus.
Conclusion: We usually attempt swallowing with head rotation toward the non-residual side to clear residue in the pyriform sinus. In this case, swallowing with head rotation toward the food residual side was effective. If there is no vocal cord palsy, this technique should be attempted.
