Dermatomyositis is a recognized paraneoplastic syndrome, with malignancy risk being an important consideration during evaluation. Its association with head and neck squamous cell carcinoma (SCC) is uncommon, and its occurrence with a presumed unknown primary has not been well documented. We report the case of an 80-year-old man who presented with dysphagia, proximal weakness, and a characteristic rash. Serology was negative, but multiple malignancy alarm features (age, dysphagia, leukocytoclastic vasculitis on biopsy) prompted aggressive screening. Fluorodeoxyglucose (FDG)-PET/CT revealed a single hypermetabolic cervical lymph node; biopsy confirmed p16-positive SCC. No mucosal primary was identified despite laryngoscopy, and further biopsies could not be performed due to rapid functional decline. The patient proved refractory to immunosuppression and was unfit for oncologic therapy. He died three months after symptom onset. This case illustrates the utility of clinical alarm features and early PET/CT in seronegative dermatomyositis, while highlighting how quickly the window for diagnosis and treatment can close.

Swallowing is a complex sensorimotor function requiring coordinated cortical and subcortical control and is frequently impaired in neurological disorders. Functional near-infrared spectroscopy (fNIRS) has emerged as a promising non-invasive neuroimaging modality for investigating swallowing-related cortical activity; however, its application in dysphagia research remains methodologically heterogeneous. This scoping review aimed to map existing evidence on the use of fNIRS in swallowing and dysphagia rehabilitation and to identify prevailing concepts and knowledge gaps. The review followed the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Electronic searches of MEDLINE, Embase, Scopus, and Web of Science were conducted from database inception to September 2025. Studies involving adult participants and task- or intervention-based fNIRS assessment of swallowing-related cortical activity were included. Twenty-one studies involving healthy adults and patients with dysphagia met the inclusion criteria. Swallowing consistently activated a distributed fronto-sensorimotor cortical network, with activation patterns modulated by sensory stimulation, motor demands, and neuromodulation. Considerable heterogeneity was observed in study design, task paradigms, optode placement, and analytical approaches, limiting cross-study comparability. Overall, fNIRS demonstrates feasibility and sensitivity for assessing swallowing-related cortical activity in both experimental and clinical contexts. However, methodological variability and the limited inclusion of clinical populations restrict the interpretation and generalizability of current findings. The development of standardized protocols and clinically relevant outcome measures will be essential for translating fNIRS into routine dysphagia assessment and rehabilitation.

Esophagitis dissecans superficialis (EDS), also known as sloughing esophagitis, is a rare, benign disorder characterized by superficial sloughing of the esophageal mucosa. Its pathogenesis remains incompletely understood, with several underlying conditions and medication exposures described as potential predisposing factors. We present the case of a 41-year-old woman with an extensive surgical history, including subtotal gastrectomy with Roux-en-Y reconstruction, who presented with chronic upper abdominal pain and bloating. Esophagogastroduodenoscopy demonstrated superficial sloughing of the esophageal mucosa consistent with EDS. Subsequent histopathologic examination confirmed the diagnosis and showed no evidence of fungal infection. Because esophageal candidiasis was initially suspected based on the endoscopic appearance, the patient was empirically treated with fluconazole and continued proton pump inhibitor therapy. Repeat endoscopy six months later demonstrated complete resolution of the esophageal abnormalities. This case highlights EDS in a patient with extensively altered foregut anatomy and illustrates its potential to mimic infectious esophagitis. Although a causal relationship between prior gastric reconstruction and EDS cannot be established, recognizing this entity and correlating endoscopic and histopathologic findings are important for accurate diagnosis.

Tetanus is uncommon in dogs, which are considered relatively resistant to tetanospasmin, and detailed descriptions of the diagnostic evaluation of severe generalized cases remain limited. A 5.5-month-old intact male Miniature Schnauzer was presented four days after a puncture wound to the right pelvic limb. On admission the dog was alert but non-ambulatory, with generalized muscle rigidity, tremors, marked cervical hyperextension, hyperactive spinal reflexes, facial muscle spasms and dysphagia. Together with the wound history and rapid progression, these findings supported a presumptive diagnosis of generalized tetanus, clinically classified as Grade III. Serum collected before tetanus antitoxin administration contained no detectable antibodies against Clostridium tetani neurotoxin. Treatment comprised equine tetanus antitoxin, antimicrobials, multimodal sedation and muscle relaxation, enteral nutrition, intensive nursing and physiotherapy. Needle electromyography on day 10 showed increased insertional activity, positive sharp waves and fibrillation potentials, and continuous spontaneous motor unit activity. Despite patient young age and rapid disease progression, clinical improvement was evident from day 10, and the dog was discharged on day 16, ambulatory and eating voluntarily. This case highlights that severe generalized canine tetanus remains principally a clinical diagnosis, while serial neurological examination, clinicopathological monitoring and electromyography can strengthen diagnostic confidence, characterize disease progression and support clinical management.

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated, non-IgE-mediated food allergy and a leading cause of dysphagia and food impaction in adults, with rising prevalence worldwide. Diagnosis requires ≥15 eosinophils per high-power field on esophageal biopsy after exclusion of other causes of gastrointestinal eosinophilia. Food allergens, principally milk, wheat, eggs, legumes and seafood, drive the inflammatory process, and treatment options include proton pump inhibitors, topical corticosteroids, biologic agents and endoscopic dilation for stricturing disease. Among these, dietary therapy is the only approach that removes the causative trigger rather than suppressing the inflammatory response, making drug-free, sustained remission achievable. Elemental diets achieve the highest histological remission rates but are poorly tolerated in practice; empiric elimination following a step-up strategy, starting with one or two foods and escalating in the absence of response, is more practical for most adults. Conventional allergy testing cannot reliably identify food triggers in EoE and is not recommended for this purpose. Reintroduction of the trigger food leads to relapse, making long-term adherence essential, and not all patients are suitable candidates: repeated endoscopy, dietary restriction, quality of life impact and the risk of avoidant restrictive food intake disorder (ARFID) are barriers that must be weighed before recommending this approach. This review summarizes the available dietary approaches in adult and adolescent EoE, covering empiric elimination strategies and their efficacy, allergy test-directed diets, patient selection, the role of diet alongside other treatments, and nutritional adequacy and adherence.

Background: Temporalis muscle thickness (TMT) measured on routine neuroimaging has emerged as a radiological marker of sarcopenia, but its prognostic value in acute ischemic stroke is not well defined. This systematic review examined whether TMT is associated with functional status, swallowing outcomes, and mortality after acute ischemic stroke. Methods: A PRISMA-guided systematic review identified observational studies (2000-2025) reporting TMT and at least one clinical outcome in adults with acute ischemic stroke. PubMed, MEDLINE, Embase, Web of Science, and Scopus were searched. Two reviewers independently screened records and extracted data. Risk of bias was assessed using ROBINS-I and the Newcastle-Ottawa Scale, with justification relative to prognostic-factor tools. Due to heterogeneity in TMT definitions and outcome measures, findings were synthesized narratively. Results: Four cohorts, including 1361 patients, met the inclusion criteria. Mean age was 69.7 years, and 53.9% were male. Study-level mean TMT ranged from 5.2 to 6.35 mm; among the 704 patients in cohorts that reported TMT-defined sarcopenia status, prevalence was 51.8% (365/704). Across studies, lower TMT or TMT-defined sarcopenia was associated with poorer functional outcomes and higher mortality, independent of age and stroke severity. In one thrombectomy cohort, each 1-mm increase in TMT increased the odds of functional independence (adjusted OR 1.14, 95% CI 1.03-1.27). In contrast, each 1-mm increase reduced 90-day mortality (adjusted OR 0.71, 95% CI 0.54-0.93). Lower TMT also predicted prolonged nasogastric tube dependence. Conclusions: TMT is a simple CT- or MRI-based measure that is consistently associated with disability, dysphagia, and survival after acute ischemic stroke. Current evidence is observational and supports further prospective validation and measurement standardization rather than immediate routine decision-making use.

Background: Dysphagia associated with Wallenberg syndrome (WS) often improves with swallowing rehabilitation; however, persistent cases may require surgical intervention. Various swallowing improvement procedures have been reported, but their strategies and outcomes remain unclear. This scoping review summarized the evidence on swallowing improvement surgery for WS. Methods: PubMed, Scopus, Web of Science, and Ichushi-Web were searched in accordance with the PRISMA-ScR framework. English- and Japanese-language studies reporting swallowing improvement surgery for WS were included. Patient characteristics, surgical procedures, outcomes, and complications were descriptively synthesized. Results: Twenty-one studies involving 53 patients met the inclusion criteria. Most patients had profound preoperative dysphagia requiring enteral feeding. Cricopharyngeal myotomy was performed in all patients, and at least 66.0% underwent combined procedures, most commonly with laryngeal suspension. Available postoperative data indicated improved oral intake in many patients, although outcome reporting was incomplete. Some patients required staged procedures because a single procedure did not adequately address their complex swallowing impairment. Conclusions: Reported outcomes suggest that swallowing improvement surgery may contribute to improved oral intake in selected patients with WS. The frequent use of combined procedures highlights the importance of individualized, pathophysiology-based surgical management. However, the evidence cannot distinguish surgical effects from spontaneous recovery, rehabilitation, or patient selection.

Background/Objectives: Early recovery after major head-and-neck reconstruction is not determined by flap survival alone. This exploratory study examined whether preoperative frailty-inflammatory phenotypes are associated with delayed swallowing recovery, persistent nutritional dependence, and poorer quality of life at 12 weeks. Methods: In a prospective single-center cohort study, 84 adults undergoing major head-and-neck oncologic reconstruction were assigned to three clinically defined phenotypes: low-risk (n = 28), intermediate (n = 29), and combined frailty-inflammatory (n = 27). Twelve-week outcomes included the Functional Oral Intake Scale (FOIS), MDADI, EORTC global health, PEG dependence, and a composite poor-recovery endpoint. Because of the small sample size, all estimates are reported to two significant figures, and every analysis is regarded as hypothesis-generating. Results: Compared with the low-risk group, the combined phenotype was older (63 ± 9 vs. 55 ± 9 years) and had a higher mFI-5 (3.2 ± 0.6 vs. 1.0 ± 0.7) and CRP/albumin ratio (2.2 ± 0.6 vs. 0.6 ± 0.2; all p < 0.001). At 12 weeks the combined phenotype showed greater weight loss (12 ± 2%), lower FOIS (3.2 ± 1.3), lower MDADI (51 ± 7), and PEG dependence in 52% (all p ≤ 0.002). A higher mFI-5 was associated with poor recovery (adjusted OR 2.1 per point; 95% CI 1.0-4.1; p = 0.04), an estimate whose confidence interval is wide and imprecise. Conclusions: In this small cohort a frailty-inflammatory framework was associated with clinically meaningful heterogeneity in early recovery. The findings are preliminary and require prospective, adequately powered, multicenter validation before any clinical use.

Background: Fatal choking is a preventable cause of mechanical asphyxia that occurs more frequently among individuals with psychiatric disorders due to behavioural abnormalities, neurological comorbidities, and medication-related swallowing impairment. This review aims to highlight the clinical and forensic factors contributing to fatal choking and the importance of a multidisciplinary approach to its investigation. Methods: A systematic review was conducted according to PRISMA guidelines by searching PubMed, Scopus, and Web of Science. In total, 25 studies describing fatal choking in adults with psychiatric disorders and including medico-legal investigations were selected and analyzed. Results: Schizophrenia was the most frequently reported psychiatric condition, followed by bipolar disorder, depression, and dementia. Antipsychotics, antidepressants, anxiolytics, and other psychotropic drugs were recurrently associated with dysphagia and reduced airway protective reflexes. Food boluses represented the predominant obstructive material, although several unusual foreign bodies were documented. Virtopsy, autopsy, histological, and toxicological investigations consistently proved essential for confirming airway obstruction, reconstructing the mechanism of death, and identifying contributing clinical and pharmacological factors. Conclusions: Fatal choking in psychiatric patients is a multifactorial event requiring early risk assessment, preventive strategies, and comprehensive forensic evaluation to improve patient safety and ensure accurate determination of the cause of death.

Background/Objectives: Oral health is important for safe oral feeding after stroke. However, the relationships among oral health-related quality of life, functional oral intake, and eating-related quality of life remain unclear. This study examined these associations in older adults with stroke. Methods: This cross-sectional observational study included 100 adults aged ≥65 years with stroke receiving oral feeding (FOIS ≥ 4). Oral health-related quality of life was assessed using the Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Impact Profile-14 (OHIP-14), and eating-related quality of life using selected Swallowing Quality of Life Questionnaire (SWAL-QOL) domains. Correlation, multiple linear regression, and exploratory parallel indirect-effect analyses were performed. Results: GOHAI was most strongly correlated with Desire to Eat (r = 0.632, p < 0.001), whereas OHIP-14 showed the strongest negative correlation with Desire to Eat (r = -0.603, p < 0.001). FOIS was positively associated with GOHAI (ρ = 0.487, p < 0.001) and negatively associated with OHIP-14 (ρ = -0.571, p < 0.001). Desire to Eat, Food Selection, and Eating Time were independently associated with GOHAI. The exploratory parallel analysis showed a statistically supported total indirect association between FOIS and GOHAI through these eating-related domains collectively (indirect effect = 2.7496, 95% bootstrap CI 0.6070 to 4.9102), while no specific indirect effect was individually supported. Conclusions: Functional oral intake, eating-related experiences, and oral health-related quality of life were significantly interrelated. The exploratory findings suggest a collective statistical indirect association through eating-related domains without establishing temporal or causal mediation.