@article{oai:niigata-u.repo.nii.ac.jp:02001175,
 author = {小貫, 和佳奈 and Onuki, Wakana and 笹, 杏奈 and Sasa, Anna and 辻, 光順 and Tsuji, Kojun and 渡邊, 賢礼 and Watanabe, Masahiro and 白石, 成 and Shiraishi, Naru and 伊藤, 加代子 and Ito, Kayoko and 真柄, 仁 and Magara, Jin and 辻村, 恭憲 and Tsujimura, Takanori and 井上, 誠 and Inoue, Makoto},
 issue = {1},
 journal = {新潟歯学会雑誌},
 month = {Jul},
 note = {Post operation of head and neck cancer often leads to dysphagia. We present the case of a 68-year-old man with post operation of tongue cancer. He underwent glossectomy, both sides neck dissection, rectus abdominis muscle flap reconstruction, tracheotomy, and gastrostomy. Physical examination performed at the initial visit revealed a firm neck muscle and failure of oral and pharyngeal transport and velopharyngeal closure due to glossectomy. Videoendoscopy and videofluoroscopy confirmed a safe bolus propulsion (2 cc of thickened liquid) at 60 degrees reclined, left lateral decubitus and right neck rotation position. Indirect and direct therapies were started. Because intraoral pain due to radiation-related oral mucositis was within manageable bounds, he started meal 29 days after the intervention. On the 35th day, he was treated with a palatal augmentation prosthesis (PAP) in order to ameliorate the oral and pharyngeal transport. However, use of PAP did not contribute to any improvement because he could not use it due to incompatibility. We confirmed that he swallowed safely at neck neutral position by videofluoroscopy on the 84th day. We expect that he could recover oral feeding without gastrostomy tube and oral stage with PAP., 頭頸部癌術後は，高頻度に摂食嚥下障害を生じる。今回，舌癌術後に摂食嚥下障害を生じ，リハビリテーションによる食形態や姿勢の調整によって経口摂取が可能となった症例を経験したので報告する。症例は68歳の男性。舌亜全摘術，両側頸部郭清術，腹直筋皮弁再建術，気管切開術，胃瘻造設術後，放射線治療開始と同時にN大学医歯学総合病院摂食嚥下機能回復部に紹介受診となった。初診時，頸部拘縮，舌切除による創部瘢痕化を伴う口腔移送不良・鼻咽腔閉鎖不全・咽頭収縮不全を認めた。嚥下内視鏡検査と嚥下造影検査により，リクライニング60度，左側臥位・右側頸部回旋位にてとろみ付液体2ccの食道流入が可能なことを確認して，毎日の間接訓練および代償法を用いた直接訓練を開始した。術後放射線治療の影響による口腔粘膜炎は自制内であり，訓練手技を獲得して耐久性が向上した介入29日目より食事開始，介入35日目には口腔移送改善を目的として舌接触補助床を用いた訓練を開始したものの，違和感や嘔気が強く常時使用にはいたらなかった。今後は，経口摂取のみでの栄養確保，歯科補綴学的アプローチによる口腔準備期の改善も可能であると考えている。},
 pages = {43--48},
 title = {舌癌術後の摂食嚥下障害に対し間接訓練ならびに直接訓練を実施した1症例},
 volume = {48},
 year = {2018}
}