{"created":"2023-06-23T12:18:59.437974+00:00","id":9798,"links":{},"metadata":{"_buckets":{"deposit":"badbbc41-560e-4441-a56a-db0365ffddfc"},"_deposit":{"created_by":21,"id":"9798","owners":[21],"pid":{"revision_id":0,"type":"depid","value":"9798"},"status":"published"},"_oai":{"id":"oai:asahi-u.repo.nii.ac.jp:00009798","sets":["46:348:384"]},"author_link":["8842","8840","343","4219","4023","4210","338","4931","4054","8841","8839","4136"],"item_10002_biblio_info_77":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2018-07","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"71","bibliographicPageStart":"65","bibliographicVolumeNumber":"45","bibliographic_titles":[{"bibliographic_title":"岐阜歯科学会雑誌"},{"bibliographic_title":"The Journal of Gifu Dental Society","bibliographic_titleLang":"en"}]}]},"item_10002_description_80":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"＜背景＞\n唾液分泌の低下した患者は、食塊形成能、潤滑作用の低下などをきたす。その結果、嚥下困難を認めることがある。しかし、口腔乾燥症と嚥下機能の関連については不明な部分も多い。今回、口腔乾燥症と嚥下障害を持つ症例にビデオ嚥下造影検査（VF）、ビデオ嚥下内視鏡検査（VE）を行ったので報告する。\n＜対象＞\n65歳女性。右側耳前部腫脹、口腔乾燥、嚥下困難感を主訴に朝日大学歯学部附属病院を受診。53歳でSjögren症候群、54歳でサルコイドーシスと診断されている。右側耳下腺炎の診断下、抗菌薬を投与した。消炎後、唾液腺造影検査で顆粒状陰影を認めた。CT画像上で唾液腺組織が脂肪組織に置換されていた。また、右側耳下腺のび漫性腫脹を認めた。唾液量を計測するサクソンテストは0.1g未満であった。唾液は粘度が極めて高い、白濁したゼリー状であった。口腔乾燥症の治療として唾液腺管洗浄、唾液腺マッサージを行った。嚥下機能スクリーニングテストでは異常がなかった。口腔乾燥症治療経過中に咽頭の飲食物残留感を訴えたためVF、VEが行われた。プリン、うどん、米飯、液体状模擬食品を用いてVFを行った。口腔の移動時間延長、嚥下反射運動後の咽頭残留を認めた。うどん、米飯については咽頭壁付着を認めた。また、飲水した後も咽頭に残留した。VEではラーメン、ゼリー、水道水を用いた。ラーメンが咽頭に残留した。飲水後も残留は無くならなかった。\n＜考察＞\n嚥下機能スクリーニングテストで異常が無かったが、模擬食品が咽頭に残留した。咽頭における異常の検出にVFとVEが有効であった。Sjögren症候群による唾液分泌低下が、食塊形成不全、輸送不全、嚥下運動機能の低下につながったと推測した。また、唾液の粘度が極度に増したことによって、粘膜と模擬食品の摩擦が増加し、これが嚥下運動の非円滑化につながったと考えた。\nBackground\nPatients with Sjögren syndrome may have failure of bolus formation and lubrication, and develop swallowing disorder as a result. Many aspects of the association between Sjögren syndrome and swallowing disorder are not clear. In this study, we investigated swallowing in a patient with dysphagia and xerostomia by videofluoroscopic examination of swallowing (VF) and videoendoscopic examination of swallowing (VE).\nCase report\nA 65-year-old woman consulted the hospital attached to the Asahi University School of Dentistry. She presented with right parotid gland swelling, xerostomia, and swallowing difficulty. She had been diagnosed with Sjögren syndrome at age 54 years and sarcoidosis at 55 years. We made a diagnosis of right parotitis, and antibiotics were given to reduce inflammation. We recognized an apple tree appearance by parotid gland sialography. Computed tomography revealed that the parotid and submandibular glands were replaced with fat tissue and the right parotid gland had diffuse swelling. The Saxon test, a saliva stimulation test, was under 0.1g. Saliva was thick and had a jelly-like viscosity. Irrigation and massage of the parotid glands were performed for treatment of saliva flow dysfunction. There was no abnormality in swallowing function screening test.\nThroughout treatment of Sjögren’s syndrome, the patient complained of pharyngeal and esophageal symptoms. VF and VE were carried out. VF assessed swallowing using pudding, udon noodles, cooked rice and tap water. Long oral transit time and pharyngeal residue after swallowing reflex were observed. Japanese udon noodles and cooked rice adhered to the pharyngeal wall. After drinking water, pharyngeal residue was observed. Noodles, gelatin jelly and tap water were used for VE examination. Noodles remained in the pharynx. After drinking water, residue was still observed.\nDiscussion\nThere was no abnormality in the swallowing function screening test, but the test food materials remained in the pharynx. VF and VE were useful for detecting abnormalities in the pharynx. It was thought that xerostomia caused by Sjögren’s syndrome led to failure of bolus formation, transit difficulty, and swallowing disorder. Friction between the mucous membrane and the test materials was increased by the increase in saliva viscosity. This resulted in reduced deglutition. 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AKITOSHI","creatorNameLang":"en"}],"familyNames":[{"familyName":"勝又","familyNameLang":"ja"},{"familyName":"KATSUMATA","familyNameLang":"en"}],"givenNames":[{"givenName":"明敏","givenNameLang":"ja"},{"givenName":"AKITOSHI","givenNameLang":"en"}],"nameIdentifiers":[{"nameIdentifier":"8842","nameIdentifierScheme":"WEKO"},{"nameIdentifier":"1000030195143 ","nameIdentifierScheme":"CiNii ID","nameIdentifierURI":"http://ci.nii.ac.jp/nrid/1000030195143 "},{"nameIdentifier":"30195143","nameIdentifierScheme":"e-Rad","nameIdentifierURI":"https://kaken.nii.ac.jp/ja/search/?qm=30195143"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2018-11-09"}],"displaytype":"detail","filename":"gifushika451_6571_2018.pdf","filesize":[{"value":"11.3 MB"}],"format":"application/pdf","licensetype":"license_11","mimetype":"application/pdf","url":{"label":"gifushika451_6571_2018","url":"https://asahi-u.repo.nii.ac.jp/record/9798/files/gifushika451_6571_2018.pdf"},"version_id":"6af03c07-7a7e-4a25-8d33-37369ac47baa"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"ビデオ嚥下造影検査","subitem_subject_scheme":"Other"},{"subitem_subject":"VF","subitem_subject_scheme":"Other"},{"subitem_subject":"ビデオ嚥下内視鏡検査","subitem_subject_scheme":"Other"},{"subitem_subject":"VE","subitem_subject_scheme":"Other"},{"subitem_subject":"嚥下障害","subitem_subject_scheme":"Other"},{"subitem_subject":"口腔乾燥症","subitem_subject_scheme":"Other"},{"subitem_subject":"Sjögren症候群","subitem_subject_scheme":"Other"},{"subitem_subject":"Videofluoroscopy","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"VF","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Videoendoscopy","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"VE","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Swallowing disorder","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Xerostomia","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"departmental bulletin paper","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"重度の口腔乾燥症により嚥下障害を併発したSjögren症候群の1例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"重度の口腔乾燥症により嚥下障害を併発したSjögren症候群の1例"},{"subitem_title":"A case of Sjögren syndrome complicated with dysphagia due to severe xerostomia","subitem_title_language":"en"}]},"item_type_id":"10002","owner":"21","path":["384"],"pubdate":{"attribute_name":"公開日","attribute_value":"2018-11-09"},"publish_date":"2018-11-09","publish_status":"0","recid":"9798","relation_version_is_last":true,"title":["重度の口腔乾燥症により嚥下障害を併発したSjögren症候群の1例"],"weko_creator_id":"21","weko_shared_id":-1},"updated":"2024-01-11T02:15:20.894615+00:00"}