Comprehensive Rehabilitation for Epiglottis Dysfunction Due to Cut Injury of Neck with Respiratory and Swallowing Problems

Abstract

: An interesting case was referred to the Physical Medicine and Rehabilitation (PMR) department with neglected ‘vulnus scissum at the left side of the neck with exposed larynx and partially cut epiglottis’. Assessment of the patient showed epiglottis dysfunction, which caused the problem of swallowing, persistent coughing with lots of sputum, and the risk of aspiration. This was resulted in malnutrition, and prolonged hospitalization lead to deconditioning. Rehabilitation program was initiated cautiously, begun with improving the general condition, nutritional status and airway protection. Rhino-Laryngo Fiberscope (RLF) was done several times to assess the function of the epiglottis. Pulmonary rehabilitation consisted of exercise for effective coughing, airway clearance, chest wall mobilization or chest expansion and trunk flexibility. Posture training was added to achieve proper position needed for feeding. Rehabilitation of the deconditioning syndrome is also essential for functional recovery. Seven weeks of rehabilitation resulted in improvement of the general condition, including nutritional status. RLF showed a functional epiglottis, which ensured normal swallowing. This case and all its effects, required a comprehensive rehabilitation program, implemented step by step to manage all problems. At the end, the goal of medical rehabilitation in improving quality of life in this patient was achieved.