脳底動脈閉塞症による重度嚥下障害に対し，マウスピースを用いた嚥下訓練が有効であった1例

Use of a mouthpiece in swallowing rehabilitation for a case of severe dysphagia following a basilar artery occlusion

　マウスピースは，歯・顎の保護だけでなく，咬合の安定をはかることで敏捷性や平衡能力が改善するなど咬合と全身との関係において，その利用が注目されている．今回，重度の構音・嚥下障害を呈し，下顎の閉鎖不全，口唇閉鎖不全を認めた症例に対し，マウスピースを導入した嚥下リハビリテーションを行い，その効果を報告した．2種類のマウスピースを作製し，3か月間使用した．導入前は，頭頸部が弛緩性麻痺のため不安定であり，口腔期・咽頭期とも重度に障害されていたが，導入後は頭頸部が安定し，下顎の閉鎖，口唇の閉鎖が可能となり，口腔期・咽頭期とも改善を示した．そして，粥・極刻み食が摂取可能となった．マウスピースによって咀嚼筋の賦活化が認められ，噛み締め時の咬合が安定した．さらに顎位の安定をはかることで，下顎運動の起点，終点の基準位置を与えられ，一連の咀嚼・嚥下運動に効率よくアプローチする方法として有効であると考えられた．

　A mouthpiece is used for not only protecting the jaw and teeth but also for improving the body balance and agility by stabilizing the bite.　We report on the effects of the mouthpiece for a case of severe dysarthria and dysphagia with incomplete closure of the mandible and the lips.　Two types of mouthpiece were made for three months of use.　Before using the mouthpiece, her head and neck were unstable due to flaccid paralysis, and the oral and pharyngeal stages of swallow were severely impaired.　After using the mouthpiece, her head and neck became stable, complete closure of the mandible and the lips was achieved, and the oral and pharyngeal stages of swallow were improved.　Finally she was able to eat minced food and porridge.　The muscles for mastication seemed to have been activated by the use of mouthpiece and the bite became stable during occlusion.　Stabilization of the mandible position gave the appropriate starting and end points of the mandibular movement.　The use of mouthpiece is considered as an efficient approach for training mastication and swallowing.