悪性リンパ腫によりVernet症候群(頸静脈孔症候群)と舌下神経麻痺を呈した嚥下障害の1例

A case of dysphagia characterized by Vernet's syndrome (jugular foramen syndrome) and hypoglossal nerve paralysis due to a malignant lymphoma

　悪性リンパ腫の頸静脈孔浸潤によりVernet症候群と舌下神経麻痺を呈した嚥下障害の1例を報告する．本例は，咽頭収縮不全，喉頭挙上不全，食道入口部開大不全，アンカー機能障害を主徴とした球麻痺タイプの嚥下障害を呈した．嚥下リハビリテーションは，患者の治療状況に合わせて行った．化学放射線治療前は安全条件での摂食訓練および問題点に対する基礎的嚥下訓練，化学放射線治療中は症例の全身状態に配慮して基礎的嚥下訓練，化学放射線治療後は残存した舌下神経麻痺に起因する問題点に対し舌接触補助床を作製し，安全条件内での段階的摂食訓練を行った．嚥下障害の改善には，放射線治療と嚥下リハビリテーションが有効であったと考えられた．

　We report a case of dysphagia characterized by Vernet's syndrome (jugular foramen syndrome) and hypoglossal nerve paralysis due to a malignant lymphoma.　The patient presented with a bulbar palsy type of dysphagia which restricted pharyngeal contraction as well as laryngeal elevation and upper esophageal sphincter opening, and impaired anchor function.　We conducted swallowing rehabilitation paying close attention to the patient's condition and the medical treatment.　Swallowing rehabilitation, feeding therapy and basic training were conducted before chemoradiation.　Only basic training was conducted during chemoradiation.　After chemoradiation, palatal augmentation prosthesis (PAP) was useful in clearing the oral residue resulting from hypoglossal nerve paralysis.　For this patient, radiation and swallowing rehabilitation were effective for improvement of dysphagia.