Sang Hee
Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Seoul, Korea
Title: Improvement of Crycopharyngeal Dysfunction after Balloon Dilatation
Biography
Biography: Sang Hee
Abstract
Introduction
• Cricopharyngeal dysfunction (CPD) has several treatment options such as botulinum toxin injection, balloon dilatation and myotomy of crycopharyngeus muscle (CPM).
• Balloon dilatation has several advantages as it is less invasive and easy to perform under videofluoroscopy guide.
• A few reports of balloon dilatation have demonstrated successful treatment effect of CPD, however none of the studies elucidated the mechanism of improvement.
• This study aims to reveal physiologic changes of CPD after videofluoroscopy-guided balloon dilatation by high resolution manometry (HRM), through a case report of a 44-year-old TBI patient who developed dysphagia with CPD, which was treated using videofluoroscopy-guided balloon dilatation.
Case report
• A 44-year-old male developed dysphagia with CPD after large epidural hemorrhage in the left brain hemisphere concurrent with diffuse axonal injury. He was transferred to the department of rehabilitation medicine at 10 weeks after the traffic accident.
• Dysphagia with CPD was manifested on videofluoroscopy swallow study (VFSS) (Fig. 1.) and videofluoroscopy-guided balloon dilatation was conducted for the first time.
• Repetitive dilatation procedures were performed at 1, 4, 7, 27 and 38 weeks after the first intervention and the successive physiological changes were observed using high resolution manometry (INSIGHT HRM; Sandhill Scientific Inc., High lands Ranch, Co, USA).
• Collected data include ratio of normal shape of UES nadir (Fig. 2.), pressure and duration of UES nadir from HRM, and Rosenbeck penetration aspiration score (Rosenbeck PAS) from VFSS.
• After the first and second interventions, definite changes of UES nadir shape and pressure were noted, however no significant changes on HRM were observed from the consecutive third to sixth interventions.
• After the second intervention, aspiration was not observed. (PAS score changed from 8 to 3)
• In short, VFSS results correlated with the changes on HRM after first and second intervention. (Table 1.)
Conclusions
• Videofluoroscopy-guided balloon dilatation intervention was successful in normalizing the abnormal UES opening pressure in a patient with CPD in long-term follow-up.
• This case report supports the early application of ballooning dilatation for CPD to be more effective in recent onset patients.
In the future, study elucidating the physiology of therapeutic effect of balloon dilatation for CPD with more patients is needed