We report the case of a 7 years and 10 months old child with a history of mitochondrial cytopathy (deficit of complexes I-III-IV of the respiratory chain) treated with vitamins B1 and B6, phenobar,
The patient was referred to the Pediatric Gastroenterology and Nutrition Service for evaluation of episodes of attachment during meals and several admissions for pneumonia.
In the anamnesis, the parents reported that they were fed with purés, but had cough and hoarseness access when swallowing.
On physical examination, the patient was in good general condition, with no signs of malaise or malnutrition, with anthropometric data in percentiles suitable for his age and sex.
The pathological findings included generalized hypotony, apraxia particulate matter, and dystonia of the oral muscles with constant drooling.
The examination revealed no abnormalities.
With all the previous data it was established the suspicion of oropharyngeal dysphagia, and the absence of videofluoroscopy at the time of the study in our center, it was performed fibroendoscopy volumes of dysphagia test / texture with different.
At rest, there were secretions in the vallecula, pharynx and piriform sinuses; after administration of different consistencies and volumes stained with methylene, 5 cc of pharynx was concluded with a tilt at rest.
With 5 cc of penetrating esophageal sphincter weight, it was observed that there was no reflex tusé of vallé tape with accumulation of the esophagus, pharynx and piriform sinuses; slowing of the opening to the esophagus.
In this patient, due to her underlying neurological pathology, a high resolution mantle was also performed to assess esophageal motility.
With this test, findings suggestive of upper esophageal sphincter were observed with poor pharyngeal pump and normal peristaltic waves alternating with very low amplitude hypertensive contraindication.
The resting pressure in the esophageal body was normal while that of the lower esophageal sphincter was at the lower limit of normality.
The diagnosis of oropharyngeal dysphagia of neurogenic etiology was established and proceeded to a multidisciplinary approach.
It was prescribed for liquids and hypercaloric diet in the form of texture consolidation, fixing it in small volumes, which showed the lowest risk of aspiration in the tests performed.
General measures were recommended such as avoiding double textures and positioning the patient during meals (erected trunk, symmetrical head, slightly flexed head), and also requested rehabilitation exercises close shoulder rehabilitation.
The evolution in years has been favorable; presents mild advances but has not been re-admitted due to aspiration pneumonia or other complications such as realization of a certificate or malnutrition, because it has not been considered a gastrostomy
