International Journal of Clinical Case Reports 2015, Vol.5, No. 34, 1-5
1
Research Report Open Access
Post-surgical Swallowing Rehabilitation Combined with Electric Stimulation to
Treat Persistent Dysphagia Arising from a Large Internal Carotid Artery
Aneurysm
Lin F.C.
1
, Lee F.Y.
2
, Din X.R.
3
, Leong C.P.
3
,
1. Department of Physical Medicine and Rehabilitation, E-Da Hospital, Kaohsiung, Taiwan
2. Department of Cardiothoracic and Vascular Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung,
Taiwan
3. Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung,
Taiwan
Corresponding author email
International Journal of Clinical Case Reports, 2015, Vol.5, No.34 doi: 10.5376/ijccr.2015.05.0034
Received: 09 Jun., 2015
Accepted: 18 Jul., 2015
Published: 24 Aug., 2015
Copyright
©
2015 Lin et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Lin F.C., Lee F.Y., Din X.R. and Leong C.P., 2015, Post-surgical Swallowing Rehabilitation Combined with Electric Stimulation to Treat Persistent Dysphagia
Arising from a Large Internal Carotid Artery Aneurysm, International Journal of Clinical Case Reports, 5(34) 1
-
5 (doi
Abstract
In this report, we describe the case of a 99-year-old woman who presented with a large extracranial internal carotid artery
aneurysm (ICAA) in the left submandibular area, which manifested as progressive dysphagia. The patient underwent
aneurysmectomy and reconstruction of the left internal carotid artery and left common carotid artery to the internal/external carotid
artery via bypass grafting. However, persistent dysphagia remained after surgery. A therapeutic strategy was employed, combining
swallowing training with transcutaneous neuromuscular electric stimulation of the swallowing muscles. The patient’s dysphagia was
gradually alleviated, and she was eventually able to eat normally and continue with previous daily activities. This case study
demonstrates the efficacy of this therapeutic strategy in combating persistent dysphagia arising from a giant ICAA-a finding relevant
to the clinical management of patients with this disease presentation.
Keywords
Carotid artery aneurysm; Dysphagia; Rehabilitation; Electric stimulation; Deglutition; Swallowing
1 Background
Carotid artery aneurysms are rare (Painter et al., 1985),
and there are very few case reports. Internal carotid
artery aneurysms (ICAAs) are usually clinically
asymptomatic, but giant ICAAs sometimes manifest
as progressive dysphagia (Kubis et al., 2000; Vasileiadis
et al., 2010), a pulsating mass (Kubis et al., 2000),
airway obstruction (Kubis et al., 2000), odynophagia,
or tonsil asymmetry (Altin et al., 2012). Dysphagia
resulting from a giant ICAA may cause compression
of the posterior pharyngeal wall (Waespe et al., 1988;
Sergi et al., 2006), vagus nerve (cranial nerve [CN] X)
(Waespe et al., 1988), glossopharyngeal nerve (CN IX)
(Decrinis et al., 1996; Waespe et al., 1988), or
hypoglossal nerve (CN XII) (Waespe et al., 1988;
Lieschke et al., 1988).
In the present study, we report the clinical outcome of
swallowing training (ST) combined with neuromuscular
electric stimulation (NMES) of the swallowing muscles
in the management of a patient with postoperative
persistent dysphagia resulting from a left ICAA.
2 Results
The patient regained swallowing function after a total
of 17 treatment sessions. She was able to maintain a
soft-food diet and drink water. Swallowing ability
improved, as assessed by bedside swallowing
evaluation (BSE), and she passed the 100-mL water
test (Table 1). The nasogastric tube was removed
successfully. She ultimately achieved level 5 on the
functional oral intake scale (FOIS). The patient showed
no signs of respiratory complication on regular
follow-ups, and she was able to continue her previous
daily activities.
3 Discussion
Giant ICAAs are clinically rare, and have hardly been
noted in the past 10 years (Painter et al., 1985; Vasileiadis
et al., 2010). Complications of giant ICAAs include
thromboembolic or neurologic complications (Painter
et al., 1985), airway compression with dyspnea (Altin
et al., 2012), compression of CNs IX–XII resulting in
hoarseness (Waespe et al., 1988; Altin et al., 2012),
and/or dysphagia (Kubis et al., 2000; Sergi et al., 2006;
Vasileiadis et al., 2010; Altin et al., 2012).
