Swallowing virtual reality as a novel diagnostic tool for severe dysphagia after deep neck infection: a case report

Abstract Introduction Deep neck infection (DNI) is a serious and potentially life-threatening condition. Dysphagia after DNI can be a consequence of substantial cervical soft tissue fibrosis, with severe cases requiring surgical intervention. Accurate evaluation of swallowing is necessary to understand the underlying pathology and to select the appropriate surgery. We present a case of severe dysphagia occurring after treatment for DNI, and dynamic swallowing virtual reality (VR) imaging and high-resolution pharyngeal manometry (HRM) were effective in diagnosis and treatment planning. Case Presentation A 52-year-old man previously underwent incision and drainage of deep neck and mediastinal abscesses secondary to dental caries. Six months after treatment, he suffered from severe dysphagia. Swallowing VR revealed extensive neck scarring and adhesions between the reactive cervical bony outgrowth and thyroid cartilage. HRM demonstrated that the pharyngeal contraction pressure from the upper to the lower regions was preserved, with the upper esophageal sphincter normally opening during swallowing. Based on these findings, the patient was diagnosed with severe dysphagia caused by extensive neck scarring and adhesions between the cervical osteoproliferation and thyroid cartilage. To address this, cervical scar resection, cervical proliferative bone reduction, laryngeal elevation, and tracheostoma reconstruction were performed, with an eventual improvement in swallowing function. Conclusions Given the complex pathophysiology of dysphagia after DNI, a comprehensive evaluation using HRM and swallowing VR is useful for evaluating these patients and is anticipated to be integrated into clinical practice in the future.