ABSTRACT
INTRODUCTION: We describe the treatment of severe dysphagia in a patient left in a persistent vegetative state after an episode of hypoxic-ischemic encephalopathy following a traffic accident. CASE REPORT: A 38-year-old man was in a persistent vegetative state since a traffic accident in 2005, which resulted in cardiopulmonary arrest and hypoxic-ischemic encephalopathy. His airway had been secured with a tracheostomy, and a gastric tube had been inserted; however, he continued to suffer from urinary tract infections, glossoptosis, and silent aspiration of saliva. Both the maxilla and mandible had very narrow dental arches, with the mandibular incisors exhibiting severe lingual inclination. COURSE: We first corrected the dentition in the narrow maxillary arch, followed by the mandibular arch. As the dental alignment improved, tongue movements appeared during oral care, and endoscopy also revealed signs of an active saliva swallowing reflex. DISCUSSION: The "training approach" generally used to treat severe dysphagia is usually impossible in persistently vegetative patients. In our patient, the tongue movements and saliva swallowing reflex appeared after we expanded the narrow dental arches, suggesting that an orthodontic approach can be effective in such cases. Our findings can be applied to similar cases of vegetative patients to facilitate better oral care and outcomes.
