Swallowed Denture in Hemiplegic Patient

초록

Seventy four year old man with hoarseness & throat discomfort was diagnosed with huge epiglottic cyst (2.7×3.0×2.3 cm), and was planned to have it removed at the department of otolaryngology. Seven days before the scheduled operation, he developed a sudden left side weakness, dysphagia, and was admitted to the department of neurology. On brain MRI, rt. thalamic infarct was revealed. After acute treatment, he was transferred to the department of physical & rehabilitation medicine for intensive rehabilitation. He was being fed with nasogastric tube due to poor dental condition and dysphagia, but had no denture at the point of transfer. He complained persistent neck pain but it was hard to know the precise symptom or the time of onset due to hoarseness and throat discomfort caused by his epiglottic cyst. Five days after transfer, videofluoroscopic swallowing study was done in order to find out the cause and type of dysphagia. Before the actual swallowing test, the patient underwent a simple lateral X-ray image to adjust the position. To our surprise, a foreign body was present inside the neck. The test was immediately stopped. According to results, the foreign body turned out to be the patient’s denture (3.6×5.7 cm) and was located under the patient’s hypopharynx. It was removed with esophagogastroscopy at the department of gastroenteology. After removing the denture, the patient’s neck pain significantly improved. Before removing the dentures patient showed a Broca’s type aphasia in K-Western Aphasia Battery, but after the procedure patient improved to near normal status. This case highlights clinical importance of impacted dentures in aging population with cerebrovascular accident who has subsequent dysphagia