Epiglottis laringeal elevasyon sırasında vestibülü kapatarak, yutma esnasında

The epiglottis plays an important role during swallowing to prevent food penetratinginto the airway by closing down the laryngeal vestibule during laryngealelevation. In case of the absence of the epiglottis, airway closure might fail. Theabsence of the epiglottis is rarely seen in patients with Pierre Robin Sequence(PRS). We report here the swallowing problems of a PRS case with absence ofthe epiglottis and the results of our interventions. A male infant who was bornby cesarean section with a weight of 3 kilograms was diagnosed with PRS. Whenhe was 11 months old, he was referred to Hacettepe University, Department ofPhysiotherapy and Rehabilitation, Swallowing Disorders Units due to a historyof aspiration pneumonia. First, a fiberoptic endoscopic swallowing evaluation(FEES) was performed and the absence of the epiglottis was recognized. Becauseof the uncomfortable feeling during FEES, videofluoroscopic swallowing evaluation(VFSE) was also performed for a more detailed swallowing evaluation. Aspirationwas seen. A nasogastric tube was inserted after VFSE, and a swallowingtherapy program was followed for 2 months. Thermal tactile stimulation to triggerswallowing reflex, laryngeal mobilization to support hyolaryngeal elevation, andneuromuscular electrical stimulation were used. VFSE was repeated after rehabilitation.Aspiration of liquid consistency continued, but he tolerated pudding consistency.At that time, liquid-restricted oral intake was started. Early diagnosis andintervention is very important in patients with absence of the epiglottis.