Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report

• Published in: Journal of medical case reports 2022-01, Vol.16 (1), p.6-6, Article 6
• Main Authors: Yamamoto, Shinsuke, Nashi, Masanori, Maeda, Keigo, Taniike, Naoki, Takenobu, Toshihiko
• Format: Article
• Language: English
• Subjects: Atrophy; Care and treatment; Case Report; Case reports; Complications and side effects; Deglutition disorders; Deglutition Disorders - etiology; Dysphagia; Dysphagia rehabilitation; Endoscopy; Fracture Fixation, Internal; Fractures; Hospitals; Humans; Intellectual disabilities; Intellectual Disability - complications; Internal fixation in fractures; Male; Mandible; Mandibular fracture; Mandibular Fractures - surgery; Mental health; Middle Aged; Ostomy; Patients; People with disabilities; Pneumonia; Postoperative dysphagia; Range of motion; Rehabilitation; Self destructive behavior; Severe intellectual disability; Surgery
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-021-03116-6

The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient's mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.