Tomohisa Ohno

Effect of palatal augmentation prosthesis on pharyngeal manometric pressure in a patient with functional dysphagia: A case report

PATIENTS A 53-year-old institutionalized male patient with a history of postoperative bilateral hypoglossal nerve injury was admitted for treatment of dysphagia. He experienced dysphagia involving oral cavity-to-pharynx bolus transportation because of restricted tongue movement and was treated with a palatal augmentation prosthesis (PAP), which resulted in improved bolus transportation, pharyngeal swallowing pressure, and clearance of oral and pharyngeal residue. The mean pharyngeal swallowing pressure at tongue base with the PAP (145.5±7.5mmHg) was significantly greater than that observed immediately after removal of the PAP (118.3±10.1mmHg; p<0.05; independent t-test). Dysphagia rehabilitation with the PAP was continued. Approximately 1 month after PAP application, the patient could orally consume three meals, with the exception of foods particularly difficult to swallow. DISCUSSION The supporting contact between the tongue and palate enabled by the PAP resulted in improvement of bolus transportation, which is the most important effect of a PAP. The increase in pharyngeal swallowing pressure at the tongue base because of PAP-enabled tongue-palate contact might play an important role in this improvement. Since a PAP augments the volume of the palate, it enables easy contact between the tongue and palate, resulting in the formation of an anchor point for tongue movement during swallowing. Thus, application of a PAP increases the tongue force, especially that of the basal tongue. CONCLUSION A palatal augmentation prosthesis helps improve pharyngeal swallowing pressure at the basal tongue region and might contribute to the decrease of oral as well as pharyngeal residue.

Comparison of Oral Assessment Results Between Non-Oral and Oral Feeding Patients: A Preliminary Study.

In the current study, evaluation and comparison of oral status was performed to confirm the necessity of oral care for non-oral feeding patients. The study involved patients consulting an attending physician in one hospitals Department of Dentistry for oral care. Based on the feeding method, participants were divided into two groups: (a) non-oral (n = 66) and (b) oral (n = 66) feeding. Characteristics and Oral Assessment Guide scores were compared between groups. The non-oral feeding group had significantly worse scores than the oral feeding group. The non-oral feeding group also showed significantly lower voice-, swallowing-, saliva-, and tongue-related scores. The poor oral status of non-oral feeding patients was clarified. The results suggest the importance of oral care for non-oral feeding patients. [Journal of Gerontological Nursing, 43(4), 23-28.].

Palatal and lingual augmentation prosthesis for patients with dysphagia and functional problems: A clinical report

This clinical report describes the treatment of a patient with insufficient tongue movement due to bilateral hypoglossal nerve palsy. A palatal augmentation prosthesis and a mandibular intraoral prosthesis (lingual augmentation prosthesis) were provided for this patient to address his functional dysphagia problems. These problems included insufficient oral to pharynx bolus transportation and displacement of the tongue to the right posterior. The 2 prostheses improved these 2 problems and also the head extension posture during swallowing. After insertion of the 2 prostheses, the patient could transport the bolus actively from the oral cavity to the pharynx.

Palatal lift prosthesis for bolus transport in a patient with dysphagia: A clinical report

A palatal lift prosthesis (PLP) is an intraoral device that provides lift for the soft palate. The usual purpose of a PLP is to reduce nasopharyngeal reflux and the hypernasal speech caused by velopharyngeal incompetence. However, for this patient, the main purpose was to relieve a functional blockage at the oropharyngeal isthmus by suspending the soft palate. A PLP with soft and flexible lift was applied in a patient with a traumatic brain injury and dysphagia. The PLP improved oropharyngeal bolus transit time by relieving the blockage at the oropharyngeal isthmus. This type of PLP may help to improve bolus transport for patients with dysphagia.

Soft obturator prosthesis for postoperative soft palate carcinoma: A clinical report

An intraoral prosthesis with a soft flexible obturator was provided for a patient with a soft palate perforation after surgical and chemoradiotherapy treatments of a soft palate tumor. An obturator composed of movable and flexible silicone was attached to a structure similar to a palatal lift; it was therefore able to move according to the movement of the soft palate, which was confirmed by endoscopic examination. The application of this prosthesis resulted in complete disappearance of hypernasality and food reflux, and the patient was able to eat without particular limitation during daytime wearing. This type of prosthesis represents a potential prosthetic approach to a soft palate nasal-oral fistula.

Change in Food Intake Status of Terminally Ill Cancer Patients during Last Two Weeks of Life: A Continuous Observation.

BACKGROUND The oral food intake of terminally ill cancer patients is known to gradually decrease, but there are few reports about how oral intake changes around the terminal stage. It is important to clarify changes in oral food intake, as such changes affect the support and care of terminally ill cancer patients. OBJECTIVE We aimed to clarify changes in oral food intake in terminally ill cancer patients during the last 2 weeks before death. METHODS This retrospective cohort study was conducted at a designated cancer center hospital in Japan from January 2013 to June 2013. The subjects were recognized as clinically terminally ill cancer patients who were hospitalized for ≥14 days, and who had death as their reason for hospital discharge. One researcher investigated basic patient information and the food intake status of the subjects using their medical records. The basic information investigated was gender, age, type of cancer, and the presence of gastrointestinal obstruction 14 days prior to death. The Food Intake LEVEL Scale (FILS) was prospectively recorded. RESULTS After applying the exclusion criteria, 108 subjects were finally included in the analysis (59 males aged 70.3 ± 13.3 years; 49 females aged 70.3 ± 14.5 years). The FILS gradually declined, and half of the subjects were unable to take food orally 6 days before death. In 81 subjects, after excluding subjects with gastrointestinal obstruction, the FILS gradually declined, and half of the subjects were unable to take food orally 4 days prior to death. CONCLUSIONS Many terminally ill cancer patients can take food orally up to a few days prior to their death. Therefore, various specialists should support the oral intake of terminally ill cancer patients until immediately before their death.