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Case Reports
. 2020 Mar 26;8(6):1142-1149.
doi: 10.12998/wjcc.v8.i6.1142.

Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports

Yu-Er Jiang  1 , Qian-Qian Lyu  1 , Feng Lin  1 , Xue-Ting You  1 , Zhong-Li Jiang  1
Affiliations
Case Reports

Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports

Yu-Er Jiang et al. World J Clin Cases. .

Abstract

Background: A swallowing disorder may occur following a brainstem stroke, especially one that occurs in the swallowing centers. Lateral medullary syndrome (referred to as LMS), a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery, has been reported to lead to more severe and longer lasting dysphagia.

Case summary: We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique (known as HEST). The two patients had no other functional incapacity back into life, but nasogastric feeding was the only possible way for nutrition because of severe aspirations. Swallowing function was evaluated by functional oral intake scale, modified water swallow test, surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration, pharyngeal residue, pharyngeal peristalsis, upper esophageal opening and the ability of deglutition. Both patients were treated with the HEST method for dysphagia and recovered quickly.

Conclusion: HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.

Keywords: Case report; Dysphagia; Hyoid-complex elevation and stimulation technique; Lateral medullary syndrome; Treatment; Upper esophageal sphincter.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Placement of electrical stimulation and balloon dilatation in the hyoid-complex elevation and stimulation technique.
Figure 2
Figure 2
Magnetic resonance imaging of the head. A: Diffusion-weighted axial magnetic resonance image showing a left lateral medullary infarction in Case 1 (see arrow); B: Diffusion-weighted axial magnetic resonance image showing a right lateral medullary infarction in Case 2 (see arrow).
Figure 3
Figure 3
Surface electromyographic signal recording of two patients before and after hyoid-complex elevation and stimulation technique treatment. A, B: For Case 1, the surface electromyographic signal recording peaked lower than 180 mV after 4-d traditional therapy (A) and higher than 270 mV after the hyoid-complex elevation and stimulation technique (B); C, D: For Case 2, the surface electromyographic signal recordings differed before (C) and after the hyoid-complex elevation and stimulation technique (D).
Figure 4
Figure 4
Initial video fluorography swallowing study showing pharyngeal residue (see arrow). A: Case 1; B: Case 2.
Figure 5
Figure 5
Initial fiberoptic endoscopic evaluation of swallowing examination showing epiglottis insufficiency in Case 1.
Figure 6
Figure 6
The swallowing sequence of pharyngeal movement.
See this image and copyright information in PMC

References

    1. El Mekkaoui A, Irhoudane H, Ibrahimi A, El Yousfi M. Dysphagia caused by a lateral medullary infarction syndrome (Wallenberg's syndrome) Pan Afr Med J. 2012;12:92. - PMC - PubMed
    1. Eker A, Kaymakamzade B, Akpinar S. Treatment of Wallenberg's Syndrome related dysphagia with pyridostigmine. Acta Neurol Belg. 2017;117:329–331. - PubMed
    1. Vigderman AM, Chavin JM, Kososky C, Tahmoush AJ. Aphagia due to pharyngeal constrictor paresis from acute lateral medullary infarction. J Neurol Sci. 1998;155:208–210. - PubMed
    1. Frost J, Robinson HF, Hibberd J. A comparison of neuromuscular electrical stimulation and traditional therapy, versus traditional therapy in patients with longstanding dysphagia. Curr Opin Otolaryngol Head Neck Surg. 2018;26:167–173. - PubMed
    1. Wei X, Yu F, Dai M, Xie C, Wan G, Wang Y, Dou Z. Change in Excitability of Cortical Projection After Modified Catheter Balloon Dilatation Therapy in Brainstem Stroke Patients with Dysphagia: A Prospective Controlled Study. Dysphagia. 2017;32:645–656. - PMC - PubMed

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