Abstract
Although several studies have suggested that dysphagia results from deep neck infections, the efficacy of swallowing rehabilitation in these cases is not fully understood. Here we report a case of dysphagia due to deep neck infection and the effect of neck stretching and passive exercise of the hyoid and larynx on dysphagia.
The patient was a 63-year-old male who had a sore throat and swollen neck. Left abscess tonsillectomy with cervical drainage was performed. Neck computed tomography revealed a deep neck infection in the left amygdala and parapharyngeal, masticator, and parotid spaces. The posterior belly of digastricus and stylohyoid was reconstructed during debridement. On postoperative day 18, cervical drainage was performed due to infection progression in the retropharyngeal space and superior mediastinum determined by neck computed tomography. On postoperative day 51, indirect therapy was conducted.
The patient had tongue muscle weakness, left facial nerve paralysis, and restricted jaw opening and laryngeal elevation. The patient presented with severe dysphagia, which restricted laryngeal elevation and upper esophageal sphincter opening by videofluoroscopic (VF) examination of swallowing on postoperative day 85. Neck stretching of suprahyoid and infrahyoid muscles with passive exercise of the hyoid and larynx was performed.
The patient showed improvements in laryngeal elevation and upper esophageal sphincter opening by VF on postoperative day 114. The extent of upward and forward movement of the hyoid bone was assessed by VF on postoperative days 85 and 114. Forward movement of the hyoid bone increased from 2.0 mm to 8.6 mm, whereas its upward movement increased from 3.9 mm to 13.7 mm. The patient could eat soft foods for dysphagia on postoperative day 149.
The cause of dysphagia in this patient may have been the neck contracted scar caused by inflammation and debridement. He showed improvements in laryngeal elevation and upper esophageal sphincter opening as the extent of upward and forward movement of the hyoid bone improved. These results suggested that neck stretching and passive exercise of the hyoid and larynx are effective for dysphagia due to deep neck infection.
