Introduction:

Ninety four percent of stroke patients have dysphagia. The aim of our study was to describe the interdisciplinary approach to the treatment of saliva swallowing.

Case presentation:

A 69-year-old male patient was admitted with ischemic stroke, a tracheostomy, and 24 days on invasive mechanical ventilation. Fiberoptic bronchoscopy at admission showed a score of 3 on the Langmore scale. When a speaking valve (SV) was placed, the patient remained with a wet voice that did not change by coughing, and blue dye tests (BDT) showed repeated positive results. Propantheline bromide and botulinum toxin (BT) were administered, and air insufflation via the subglottic port (SP) was applied. The severity and frequency of sialorrhea and saliva volume per shift were evaluated. A continuous-flow (CF) device was used for treatment. Contraction was then observed in the anterior pillars and posterior wall of the pharynx. A subsequent BDT showed a negative result in sitting position and a positive result in supine position. The patient tolerated the SV for longer periods, and within a month, he was able to tolerate it for 24 hours a day.

Conclusion:

An interdisciplinary approach with the application of BT and CF could be beneficial in stroke patients with swallowing disorders and sialorrhea.

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