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경동맥 내막절제술 후의 설하신경 손상 - 증례 보고 -
성진완,황창호 대한근전도전기진단의학회 2012 대한근전도 전기진단의학회지 Vol.14 No.2
Carotid endarterectomy(CEA) has been performed to remove the carotid lesions when plaques are suspected as the cause of the cerebro-vascular accidents. The complications of the central and peripheral nervous system have been reported. Among those, hypoglossal nerve injury is the most common one. CEA was provided to two male patients with cerebral infarction. After CEA, they suffered from the dysarthria, tongue atrophy, tongue deviation, dysphagia, and voice change. Nerve conduction study and electromyography were performed. Denervation potentials, polyphasic motor unit action potential of long duration and decreased recruitment were found in the tongue, and hypoglossal neuropathy was confirmed. Video fluoroscopic swallowing study showed the oral phase dysfunction, and swallowing training and speech therapy were provided. Over a few weeks, they could start to eat general diet and verbal symptoms were improved. This is the first report of the hypoglossal nerve injury following CEA in Republic of Korea.
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The Effects of Removable Denture on Swallowing
손대식,성진완,김영훈,지영준,황창호 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.2
Objective To investigate the relationship between removable dentures and swallowing and describe risks.Methods Twenty-four patients with removable dentures who were referred for videofluoroscopic swallowing study (VFSS) were enrolled. We evaluated the change of swallowing function using VFSS before and after the removal of the removable denture. The masticatory performance by Kazunori’s method, sensation of oral cavity by Christian’s method, underlying disease, and National Institutes of Health Stroke Scale for level of consciousness were collected. Functional dysphagia scales, including the oral transit time (OTT), pharyngeal transit time (PTT), percentage of oral residue, percentage of pharyngeal residue, oropharyngeal swallow efficiency (OPSE), and presence of aspiration were measured. Results Four patients dropped out and 20 patients were analyzed (stroke, 13 patients; pneumonia, 3 patients; and others, 4 patients). The mean age was 73.3±11.4 years. There were significant differences before and after the removal of the denture for the OTT. OTT was significantly less after the removal of the denture (8.87 vs. 4.38 seconds, p=0.01). OPSE increased remarkably after the removal of the denture, but without significance (18.24%/sec vs. 25.26%/sec, p=0.05). The OTT and OPSE, while donning a removable denture, were correlated with the masticatory performance (OTT, p=0.04; OPSE, p=0.003) and sensation of oral cavity (OTT, p=0.006; OPSE, p=0.007).Conclusion A removable denture may have negative effects on swallowing, especially OTT and OPSE. These affects may be caused by impaired sensation of the oral cavity or masticatory performance induced by the removable denture.
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