Dysphagia

, Volume 22, Issue 3, pp 187–192 | Cite as

Management of Dysphagia in Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome (SJS)

Article
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Abstract

Toxic epidermal necrolysis (TEN) is a rare and potentially fatal skin disorder, precipitated by severe allergic drug reaction, and is one of a spectrum of conditions, which includes Stevens-Johnson syndrome (SJS). Mucosal involvement is common, resulting in extreme pain on swallowing and poor oral intake. The aim of this study was to describe swallow function in TEN and SJS and define the role of Speech Pathology in management. The Burns Unit database was reviewed for patients that presented over a five-year period with TEN and SJS. Diagnosis of TEN and SJS was confirmed by skin biopsy. Information specific to swallow function, treatment approaches, and adequacy of oral intake was collected. Fourteen patients’ medical records were studied: eight TEN, two TEN/SJS spectrum, and four SJS. The majority had mucosal involvement causing odynophagia, poor oral intake, an ability to tolerate fluids more easily than solids, and increased aspiration risk. These symptoms were confirmed by Speech Pathology swallowing assessment. Severe mucosal involvement resulting in odynophagia, dysphagia, and poor oral intake is common in TEN and SJS. The speech pathologist is able to assess swallow function and provide recommendations to promote safe oral intake, minimize odynophagia, and facilitate nutritional input critical to optimizing recovery.

Keywords

Toxic epidermal necrolysis Stevens-Johnson syndrome Mucosal involvement Dysphagia Odynophagia Management Deglutition Deglutition disorders 
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References

  1. 1.
    Barrera JE, Meyers AD, Hartford EC: Hypopharyngeal stenosis and dysphagia complicating toxic epidermal necrolysis. Arch Otolaryngol Head Neck Surg 124:1375–1376, 1998PubMedGoogle Scholar
  2. 2.
    Fish J: Toxic epidermal necrolysis: the role of burns units in treating these massive cutaneous wounds. Problems Gen Surg 20(1):20–128, 2003Google Scholar
  3. 3.
    Nasser M, Bitterman-Deutsch O, Nasser F: Intravenous immunoglobulin for treatment of toxic epidermal necrolysis. Am J Med Sci 329(2):95–98, 2005PubMedCrossRefGoogle Scholar
  4. 4.
    Palmieri TL, Greenhalgh DG, Saffle JR, Spence RJ, Peck MD, Jeng JC, Mozingo DW, Yowler CJ, Sheridan RL, Ahrenholz DH, Caruso DM, Foster KN, Kagan RJ, Voigt DW, Purdue GF, Hunt JL, Wolf S, Molitor F: A multicenter review of toxic epidermal necrolysis treated in US burns centers at the end of the twentieth century. J Burn Care Rehabil 23(2):87–96, 2002PubMedCrossRefGoogle Scholar
  5. 5.
    Huang DB, Wu JJ, Lahart CJ: Toxic epidermal necrolysis as a complication of treatment with voriconazole. South Med J 97(11):1116–1117, 2004PubMedCrossRefGoogle Scholar
  6. 6.
    Rzany B, Hering O, Mockenhaupt M, Schroder W, Goerttler E, Ring J, Schopf E: Histopathological and epidemiological characteristics of patients with erythema exudativum multiform major, Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol 135(1):6–11, 1996PubMedCrossRefGoogle Scholar
  7. 7.
    Staneloni MC, Maffione L, Greco A, Longarini V, Santucci C, Hermilla V, Martin M, Basilio V, Matteo P, Yanivello V, Goyeneche B, Filinger E: Serious cutaneous reaction to drugs: Stevens-Johnson and epidermical toxic necrolysis syndromes. Acta Farmaceutica Bonaerense 23(4):546–549, 2004Google Scholar
  8. 8.
    Dawe S, Bentley R, Creamer D: Toxic epidermal necrolysis complicated by delayed mucosal healing and haemorrhagic mucositis. Clin Exp Dermatol 28(4):454–455, 2003PubMedCrossRefGoogle Scholar
  9. 9.
    Bastuji-Garin S, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau J-C: Clinical classification of cases of toxic epidermal necrolysis, Steven-Johnson syndrome, and erythema multiforme. Arch Dermatol 129:92–96, 1993PubMedCrossRefGoogle Scholar
  10. 10.
    Ward EC, Uriarte M, Conroy AL: Duration of dysphagic symptoms and swallowing outcomes after thermal burn injury. J Burn Care Rrehabil 222(6):441–453, 2001CrossRefGoogle Scholar
  11. 11.
    McKinnon DuBose C, Groher MG, Carnaby Mann G, Mozingo D: Pattern of dysphagia recovery after thermal burn injury. J Burn Care Rehabil 26(3):233–237, 2005Google Scholar
  12. 12.
    Goldsmith T: Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin 3(3):219–242, 2000CrossRefGoogle Scholar
  13. 13.
    Tolep K, Getch CL, Criner GJ: Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest 109:167–172, 1996PubMedGoogle Scholar
  14. 14.
    Bonanno PC: Swallowing dysfunction after tracheostomy. Ann Surg 174:29–33, 1970CrossRefGoogle Scholar
  15. 15.
    Nash M: Swallowing problems in the tracheostomized patient. Otolaryngol Clin North Am 21:701–709, 1988PubMedGoogle Scholar
  16. 16.
    Shaker R, Milbrath M, Ren J, Campbell B, Toohill R, Hogan W: Deglutitive aspiration in patients with tracheostomy: effect of tracheostomy on the duration of vocal cord closure. Gastroenterology 108:1357–1360, 1995PubMedCrossRefGoogle Scholar
  17. 17.
    Sasaki CT, Suzuki M, Horiuchi M, Kirshner JA: The effect of tracheostomy on the laryngeal closure reflex. Laryngoscope 87:1428–1433, 1977PubMedGoogle Scholar
  18. 18.
    Feldman SA, Deal CW, Urquart W: Disturbance of swallowing after tracheostomy. Lancet 1:954–956, 1966PubMedCrossRefGoogle Scholar
  19. 19.
    Williams AI, Baker BM: Advances in burn care management: role of the speech-language pathologist. J Burn Care Rehabil 13(6):642–649, 1992PubMedCrossRefGoogle Scholar
  20. 20.
    Snyder C, Ubben P: Use of speech pathology services in the burn unit. J Burn Care Rehabil 24(4):217–222, 2003PubMedCrossRefGoogle Scholar
  21. 21.
    Bartlett RH, Allyn PA, Medley T, Wetmore N: Nutritional therapy based on positive caloric balance in burn patients. Arch Surg 112:974–980, 1977PubMedGoogle Scholar
  22. 22.
    Kemper M, Weissman C, Hyman AI: Caloric requirements and supply in critically ill surgical patients. Crit Care Med 20(3):344–348, 1992PubMedCrossRefGoogle Scholar
  23. 23.
    NSW State-wide Severe Burns Injury Service: Emergency Management of Severe Burns Manual. City: Publisher, 2005Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Burns UnitConcord Repatriation General HospitalConcordAustralia

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