共存性垂头综合征与吞咽困难的诊断和管理挑战：一例病例报告及文献综述

文献信息

中文摘要

背景： 本文提出了一种针对共存性垂头综合征（DHS）和吞咽困难的综合诊断方法，二者均与颈部放疗的长期并发症相关。所报告的症状在放疗后常见，但其共存、因果关系以及距初始治疗的年限共同构成了本病例的独特性。本文还包括对该主题的文献综述。
病例介绍： 一名54岁白人男性表现为进行性颈部伸肌无力，符合垂头综合征（DHS），并伴有吞咽困难和声音改变，发生于霍奇金淋巴瘤放疗后17年。全面的临床和仪器评估，包括视频荧光吞咽研究（VFSS）、肌电图（EMG）和磁共振成像（MRI），显示轻至中度吞咽困难，特征为吞咽效率降低，会厌谷和梨状窦残留（>50%占据），穿透-误吸量表评分为1（无误吸）。这些发现与涉及颈部区域的姿势和神经肌肉改变一致。手法头部支撑可改善食团清除。一项结构化的2周康复计划与生活质量改善（如SWAL-QOL评分改善所报告）和营养状况稳定相关，尽管随访肌电图检查未记录到客观生理变化。据我们所知，这是首项描述在既往接受头颈部恶性肿瘤放疗的患者中考虑与DHS相关的迟发性吞咽损害重要性的研究。
结论： DHS与吞咽困难的共存，二者均与颈部放疗的长期并发症相关，需要一种目前在相关文献中缺乏的全面诊断方法。吞咽评估和筛查应成为影响头颈部区域肿瘤长期随访中的标准程序。该研究强调了在放疗后吞咽困难中考虑神经肌肉病理生理和机械机制的重要性。

英文摘要

BACKGROUND: This paper presents a comprehensive diagnostic method for coexisting dropped head syndrome (DHS) and dysphagia, both associated with long-term complications of neck radiation. The symptoms reported are common after radiotherapy, but their co-occurrence, causal link, and the years since the initial treatments all contribute to the uniqueness of the case presented. A literature review on the topic is also included.
CASE PRESENTATION: A 54-year-old White male presented with progressive neck extensor weakness consistent with dropped head syndrome (DHS), associated with dysphagia and voice changes, occurring 17 years after radiotherapy for Hodgkin's lymphoma. A comprehensive clinical and instrumental evaluation, including a videofluoroscopic swallowing study (VFSS), electromyography (EMG), and magnetic resonance imaging (MRI), revealed mild-to-moderate dysphagia characterized by reduced swallowing efficiency, with residue in the valleculae and pyriform sinuses (> 50% occupancy) and a Penetration-Aspiration Scale score of 1 (no aspiration). The findings were consistent with postural and neuromuscular alterations involving the cervical region. Bolus clearance improved with manual head support. A structured 2-week rehabilitation program was associated with improved quality of life (as reported by improvement in the SWAL-QOL score) and stable nutritional status, though no objective physiological change was documented on the follow-up electromyographic exam. To our knowledge, this is the first work describing the importance of considering delayed-onset swallowing impairment associated with DHS in patients previously treated with radiotherapy for head-and-neck malignancies.
CONCLUSIONS: The co-occurrence of DHS and dysphagia, both related to long-term complications of neck radiation, necessitates a comprehensive diagnostic approach that is currently lacking in the relevant literature. Swallowing assessments and screenings should be standard procedures in the long-term follow-up of tumors affecting the head-and-neck regions. The study underscores the importance of considering neuromuscular pathophysiological and mechanical mechanisms in post-radiotherapy dysphagia.