Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study

• Published in: Progress in Rehabilitation Medicine Vol. 5; p. 20200002
• Main Authors: Koyama, Yuji, Isaji, Yuri, Sugimoto, Ayaka, Tochikura, Michi, Kasahara, Takashi, Toyokura, Minoru, Masakado, Yoshihisa
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Association of Rehabilitation Medicine 2020; JARM
• Subjects: Case Report; chin-down postural technique; deglutition; deglutition disorders; descending necrotizing mediastinitis; dysphagia; deglutition; dysphagia; chin-down postural technique; descending necrotizing mediastinitis; deglutition disorders
• ISSN: 2432-1354; 2432-1354
• DOI: 10.2490/prm.20200002

Background: Descending necrotizing mediastinitis is a potentially fatal polymicrobial infection that often leads to dysphagia after treatment. Such dysphagia is likely the result of fibrosis and scarring from inflammatory changes in the fascial space. A case is presented in which the mechanism of dysphagia was verified using two-dimensional analysis of the muscle lengths of the suprahyoid and infrahyoid muscles. Case: A 57-year-old woman presented with a hyoid and laryngeal movement disorder with pharyngeal residue secondary to descending necrotizing mediastinitis. To treat this disorder, the chin-down maneuver was performed, and it immediately improved hyoid and laryngeal elevation and reduced pharyngeal residue at the epiglottic valleculae and pyriform sinus. Analysis of the mechanism of these improvements revealed that combined head and neck flexion, compared with neck flexion, decreased the distance between the origin and insertion (DOI) of the sternohyoid muscle (SM) and increased the muscle contraction rate and the maximum contraction duration of the geniohyoid muscle (GM) during swallowing. Discussion: In the present case, the patient had restrictions in extension of the SM that applied resistance to GM contraction. Compensation of this condition was achieved by combined head and neck flexion, which decreased the DOI of the SM, thereby improving the contractile function of the GM.