[Botulism and dysphagia].
BACKGROUND
Botulism is a severe neuroparalytic, of an acute characteristic, afebrile and is caused by the action of a toxin produced by Clostridium botulinum. This toxin links itself to the receptors of the axon membrane of the motor neurons, preventing the release of acetylcholine in the neuromuscular junction, causing flaccid paralysis of the cranial nerves and skeleton musculature.


OBJECTIVE
To present the speech therapy procedures adopted with a patient with botulism and who was presenting dysphagia.


METHODS
A male adult, with botulism, sent for a speech-language evaluation due to the presence of difficulties when swallowing saliva. During the evaluation the following was observed: alteration in mobility, tonicity and sensibility of the organs of the Orofacial Myofunctional System (OMSs); reduction of the laryngeal movements; stasis of saliva in the oral cavity; absence of the swallowing reflex; absence of the swallowing function. Nine speech therapy sessions were carried out with the following procedures: stimulation of the OMSs--mobility, tonicity and sensibility; stimulation of the oral and pharyngeal reflexes; tests and trainings for swallowing with different food consistencies and with the help of maneuvers aiming at the protection and clearing of the airways.


RESULTS
Improvement in mobility, tonicity and sensibility of the OMSs; improvement in the elevation of the larynx; re-establishment of the swallowing function without the assistance of other professionals or clinical maneuvers; vocal quality close to the normal parameters (light hypernasality and pneumophonoarticulatory incoordination). The patient was discharged from hospital and speech therapy; clinical assistance for adjustment and improvement of the OMSs was suggested.


CONCLUSIONS
Speech therapy demonstrated to be efficient in the re-establishment of OMSs and of the swallowing function, enabling the patient to restore the adequate functionality of his orofacial myofunctional system.
Mangilli
Laura Davison
LD
Programa de Pós-Graduação em Ciencias da Reabilitação, Faculdade de Medicina, Universidade de São Paulo, Brazil. davisonmangilli@yahoo.com.br
Andrade
Claudia Regina Furquim de
CR
D000328:Adult; D001906:Botulism / Q000150:complications*; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D013064:Speech Disorders / Q000517:prevention & control; D013070:Speech Therapy; D014140:Tracheotomy