Videofluoroscopy-Guided Balloon Dilatation for the Opening Dysfunction of Upper Esophageal Sphincter by Postoperative Vagus Nerve Injury: A Report on Two Cases
A 72-year-old man who had a retropharyngeal abscess underwent abscess removal surgery. After the operation, he complained of dysphagia. He was diagnosed as right vagus nerve palsy, showing hoarseness and abnormal position of right vocal cord on laryngoscopy.\nVFSS demonstrated a firmly closed UES. The patient could not swallow food and liquid through UES at all, and aspiration occurred by pyriform sinus residue with grade 3 (). He was nourished by nasogastric tube for six weeks and had conventional dysphagia therapy without any improvements. He received eleven trials of videofluoroscopy-guided balloon dilatation for two months with the same method as described in case 1. The UES opening improved, and no aspiration was observed in the final VFSS (). He could swallow 5 mL of yogurt pudding in four swallowing efforts to reach grade 0 of pyriform sinus residue () and started oral intake. The clinical symptom score and the disability rating score improved from 10 to 4 and 4 to 1, respectively. Other neurologic symptoms continued for two months after the termination of ballooning. Dysphagia has not recurred for over a year.