2021 Volume 25 Issue 3 Pages 259-266
Introduction: We report a patient who achieved oral intake by direct swallowing training after wearing the AGO Cap™ (AGO Cap) chin external fixation device.
Case: A woman in her 80s was admitted to the hospital with Alzheimer’s disease and interstitial pneumonia.
Course: Interstitial pneumonia worsened and the patient’s consciousness decreased on Day 2. A speech-language-hearing therapist intervened on Day 3 to evaluate swallowing function. The general condition became unstable, and long-term bed rest, increased sputum volume, and delirium appeared. The patient repeatedly dislocated the temporomandibular joint (TMJ) while at rest, and was able to self-repair. The patient's general condition improved and direct swallowing training was started on Day 21. Bilateral dislocations of the TMJ with difficulty in self-repair appeared on Day 28. We tried a chin cap and a TMJ brace to prevent re-dislocation after manual reduction, but adaptation was poor. Therefore, direct swallowing training was performed with the AGO cap in place. The anterior protrusion of the head and neck with thoracic kyphosis improved, resulting in an enhanced amount of opening and mastication. When the AGO cap was not attached, the amount of opening was small and mastication was slow, and the distance between the upper and lower incisors gradually prolonged and dislocated. The patient continued swallowing training using the AGO cap, and finally achieved oral intake on Day 38. The patient's general condition deteriorated on Day 47 just before scheduled discharge, and she died on Day 51.
Discussion: The AGO cap has sufficient fixation force to prevent re-dislocation, and is easy to put on and take off with little discomfort during wearing. In the case of habitual temporomandibular joint dislocation with dementia, the cap is expected to have the psychological effect of dispelling the fear of dislocation and assisting the acquisition of swallowing function. Swallowing training after AGO cap placement may contribute to the improvement of swallowing function, especially during the preparatory and oral phases. The AGO cap is expected to be applied to patients even with difficulty in closing the mouth, in addition to TMJ dislocation.
