Wakabayashi Hidetaka    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor and Division head
Article types	Case report
Language	English
Peer review	Peer reviewed
Title	Glottal Closure Surgery for Dysphagia Associated with Cerebral Hemorrhage, Tongue Defect, and Sarcopenia: A Case Report
Journal	Formal name：Progress in rehabilitation medicine Abbreviation：Prog Rehabil Med ISSN code：24321354/24321354
Domestic / Foregin	Domestic
Volume, Issue, Page	3,pp.20180020
Author and coauthor	Kishima Masako, Wakabayashi Hidetaka, Kanazawa Hideaki, Itoda Masataka, Nishikimi Toshio, Kishima Masako, Wakabayashi Hidetaka, Kanazawa Hideaki, Itoda Masataka, Nishikimi Toshio
Authorship	2nd author
Publication date	2018
Summary	Background: Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure. Case: At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient’s Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient’s nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient’s FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge. Discussion: Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.
DOI	10.2490/prm.20180020
PMID	32789245