2019 Volume 23 Issue 3 Pages 189-193
Introduction: We present a case in which movements of the epiglottis caused by cervical osteophyte were improved by postural adjustments made under video fluorography.
Case: The patient, a 76-year-old man, had suffered a pontine infarction 7 years before the current presentation. During his hospitalization for treatment of chronic prurigo, the patient developed aspiration pneumonia and acute empyema.
Course: As silent aspiration was suspected, we performed video fluorography but found no evidence of aspiration. However, the epiglottis was in contact with a beak-shaped osteophyte arising from the anterior cervical spine (at C4-C5), which interfered with epiglottic movements, hindering the passage of bolus. Additionally, the epiglottis did not invert at times, and pharyngeal residues and dysphagia were noted. Under video fluorography, we adjusted the patient’s weight bearing on the seat surface, as well as the head and neck position, which led to improved movements of the epiglottis and pharyngeal clearance. At meal times, the patient was encouraged to move both hands and gained the ability to consistently hold dishes as he ate, which allowed him to maintain the posture adjusted under video fluorography. Aspiration pneumonia did not recur throughout the remainder of his hospital stay.
Discussion: It was estimated to be in addition to the beak-shaped cervical plexus, another factor underlying the epiglottis movement disorder is the insufficiency of the tongue base retraction caused by the bridge infarct and the poor forward movement of the hyoid bone. Video fluorography is useful for postural adjustment, in which the patient switches his weight bearing on the seat surface from sacral support to ischial support and changes the position of the head and neck so that the chin is down. Maintaining this position probably aided the retraction of the tongue base during swallowing and helped to expand the pharyngeal cavity and promote epiglottis inversion.
