ヘルペス脳炎後の嚥下障害に対し，喉頭蓋管形成術 (Biller変法) を施行した1例

概要

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This report presents the case of a patient treated with epiglottoplasty (Billers laryngoplasty technique) for the pseudobulbar type of dysphagia associated with herpes simplex encephalitis (HSE). A 67-year-old man developed acute HSE with disturbance of consciousness and intractable aspiration. Oral intake was tried, but resulted in aspiration pneumonia and was therefore canceled at the patients former institution. At 12 months following onset, the patient consulted our hospital and we judged that aspiration could not be controlled, and that surgical management would be needed. In order to both prevent aspiration and preserve phonation, epiglottoplasty was performed at 15 months following onset. Postoperatively, the patient was able to resume an unrestricted diet except for clear liquids. He also underwent voice rehabilitation with the support of his family and rehabilitation staff. These efforts finally enabled him to speak clearly. Epiglottoplasty is an effective treatment for intractable aspiration, but this procedure is not widely known to Japanese physiatrists. Careful patient screening and selection by the attending physiatrist is essential, as is providing adequate postoperative swallowing and voice rehabilitation.