Oral Appliances Improve Dysphagia following Intracranial Epidermoid Tumor Removal in a Developmentally Disabled Child : A Case Report

頭蓋内類表皮腫摘出後に嚥下障害を生じた発達障害児(初診時8歳5カ月,女児)に対し,耳鼻咽喉科医師と連携し,Videofluorography(以下VF)による診断に基づき口腔内に装置を適用し,舌の訓練と嚥下動作の改善を行い,以下の治療効果を得た. 1.舌挙上訓練のため,接歯唇側線およびビーズアタッチメントを取り付けた可撤式の装置による治療を開始した.装置適用6カ月後,開咬の改善とoverjetの減少および嚥下機能の改善がみられた. 2.初診から1年後,開咬の再発はなかったが,VF検査にて再び嚥下動作に異常がみられたため,食事時にも舌挙上を補助できる固定式の舌挙上装置に変更して治療を継続した. 3.初診2年後のVF検査にて,嚥下機能の改善が確認できた.さらに1年後のVF所見でも嚥下機能が改善した状態が維持されていた. 4.治療により最長で2時間かかっていた食事時間が30分に短縮された. なお,この患児の嚥下障害の原因が判明していないため,装置の必要性、あるいは撤去時期については,注意深く経過観察をしたうえで決定する必要がある.We treated dysphagia that presented after intracranial epidermoid tumor removal in a developmentally disabled child (female, aged 8 years 5 months at the time of initiale xamination).An intraoral appliance followed by a tongue-lifting device were used to improve swallowing based on videofluorographic(VF) diagnosis in collaboration with an otorhinolaryngologist. We observed the following therapeutic results. 1. The treatment was initiated using a removable oral appliance with a labial arch and a bead attachment (palatal training appliance).A fter using this appliance for 6 months, the patient showed improved apertognathia and reduced overjet. VF analysis also demonstrated improved swallowing. 2.Although there was no recurrence of apertognathia, VF showed the recurrence of abnormal swallowing movements 1 year after the initiale xamination. Thus, we altered treatment by switching to a fixedt ongue-1ifting appliance that can supplement tongue-lifting during eating. One year later, VF analysis showed improved swallowing that was maintained for the following year. 3.The time spent eating for the patient, which upon admission was up to 2 h, had reduced to 30 min because of this treatment. As the cause of dysphagia in this child remains unclear, the need for these oral appliances and the timing of their removal must be carefully monitored during follow-up