Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study.
chin-down postural technique
deglutition
deglutition disorders
descending necrotizing mediastinitis
dysphagia
Journal
Progress in rehabilitation medicine
ISSN: 2432-1354
Titre abrégé: Prog Rehabil Med
Pays: Japan
ID NLM: 101707740
Informations de publication
Date de publication:
2020
2020
Historique:
received:
03
09
2019
accepted:
04
02
2020
entrez:
14
8
2020
pubmed:
14
8
2020
medline:
14
8
2020
Statut:
epublish
Résumé
Descending necrotizing mediastinitis is a potentially fatal polymicrobial infection that often leads to dysphagia after treatment. Such dysphagia is likely the result of fibrosis and scarring from inflammatory changes in the fascial space. A case is presented in which the mechanism of dysphagia was verified using two-dimensional analysis of the muscle lengths of the suprahyoid and infrahyoid muscles. A 57-year-old woman presented with a hyoid and laryngeal movement disorder with pharyngeal residue secondary to descending necrotizing mediastinitis. To treat this disorder, the chin-down maneuver was performed, and it immediately improved hyoid and laryngeal elevation and reduced pharyngeal residue at the epiglottic valleculae and pyriform sinus. Analysis of the mechanism of these improvements revealed that combined head and neck flexion, compared with neck flexion, decreased the distance between the origin and insertion (DOI) of the sternohyoid muscle (SM) and increased the muscle contraction rate and the maximum contraction duration of the geniohyoid muscle (GM) during swallowing. In the present case, the patient had restrictions in extension of the SM that applied resistance to GM contraction. Compensation of this condition was achieved by combined head and neck flexion, which decreased the DOI of the SM, thereby improving the contractile function of the GM.
Sections du résumé
BACKGROUND
BACKGROUND
Descending necrotizing mediastinitis is a potentially fatal polymicrobial infection that often leads to dysphagia after treatment. Such dysphagia is likely the result of fibrosis and scarring from inflammatory changes in the fascial space. A case is presented in which the mechanism of dysphagia was verified using two-dimensional analysis of the muscle lengths of the suprahyoid and infrahyoid muscles.
CASE
METHODS
A 57-year-old woman presented with a hyoid and laryngeal movement disorder with pharyngeal residue secondary to descending necrotizing mediastinitis. To treat this disorder, the chin-down maneuver was performed, and it immediately improved hyoid and laryngeal elevation and reduced pharyngeal residue at the epiglottic valleculae and pyriform sinus. Analysis of the mechanism of these improvements revealed that combined head and neck flexion, compared with neck flexion, decreased the distance between the origin and insertion (DOI) of the sternohyoid muscle (SM) and increased the muscle contraction rate and the maximum contraction duration of the geniohyoid muscle (GM) during swallowing.
DISCUSSION
CONCLUSIONS
In the present case, the patient had restrictions in extension of the SM that applied resistance to GM contraction. Compensation of this condition was achieved by combined head and neck flexion, which decreased the DOI of the SM, thereby improving the contractile function of the GM.
Identifiants
pubmed: 32789270
doi: 10.2490/prm.20200002
pii: 20200002
pmc: PMC7365184
doi:
Types de publication
Case Reports
Langues
eng
Pagination
20200002Informations de copyright
©2020 The Japanese Association of Rehabilitation Medicine.
Déclaration de conflit d'intérêts
CONFLICTS OF INTEREST: No conflicts of interest have been reported by the authors or by any individuals in control of the content of this study.
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