Bildiri_Kitabi

“Tanıdan Tedaviye Nörojenik Yutma Bozuklukları”
12-14 Nisan 2017, Ankara
TRANSORAL ENDOSCOPİC LASER CRİCOPHARYNGEAL
MYOTOMY İN THE TREATMENT OF PHARYNGEAL DYSPHAGİA
AFTER STROKE
Ozan Bağış ÖZGÜRSOY 1 , Selen SEREL ARSLAN 2 , Numan DEMİR 2
1
Ankara University Faculty of Medicine Department of Otolaryngology
2
Hacettepe University Faculty of Health Sciences Department of Physiotherapy and
Rehabilitation
PURPOSE: To present an endoscopic surgical technique than can be used in
the treatment of pharyngeal dysphagia after stroke.
MATERIAL and METHOD: A sixty-nine year old female presented with
dysphagia which developed after stroke ten months ago, progressed within
months and limited his oral intake. Dysphasia did not get better despite of
diet modifications and swallowing therapy. Videoflouroscopic examination
revealed a cricopharyngeal bar blocking bolus transit at the level of upper
esophagial sphincter. Transoral endoscopic injection of botulinum toxin into
the cricopharygeal area was performed first. Patient came back with same
complaints four months later and a transoral endoscopic carbondioxide laser
cricopharyngeal myotomy was performed.
RESULTS: Patient was fed through a nasogastric tube for 2 days after surgery
and a soft diet was given at the 3rd day. The patient tolerated this diet, and
water and liquids were given at the 4th day. Nasogastric tube was removed
and the patient was discharged at the 5th day. At postoperative 10th day visit,
patient reported that he was able to swallow better than that before the surgery
but, having some reflux symptoms. After seeing that subjective improvement,
a proton pump inhibitor twice a day was prescribed and a follow-up visit was
scheduled for 3 months later.
DISCUSSION: A long-standing pharyngeal dysphagia in stroke patients can
cause severe medical and social problems by limiting oral intake. Hence, diet
modifications and swallowing therapy should be applied to all symptomatic
stroke patients. Succesful results have been reported after transoral endoscopic
cricopharyngeal myotomy in some patients who did not respond to this therapy.
Endoscopic myotomy has success rates similar to those of transcervical open
myotomy, however, it is preffred over open surgery because of its low rates of
morbid and mortal complications (mediastinitis and pharyngocutaneus fistula).
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