Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Maxillofacial and Oral Surgery

12-04-2024 | Botulinum Toxin | CASE REPORT

Botulinum Toxin Injection under Electromyography Guidance for the Treatment of Primary Dysfunction of Cricopharyngeal Muscle

Authors: Beatriz Delgado-Vargas, Leticia Acle-Cervera, Miguel Ángel Saiz Sepúlveda, Blanca Díaz Montoya

Published in: Journal of Maxillofacial and Oral Surgery

Login to get access

Abstract

Background

Cricopharyngeal dysfunction produces dysphagia of different severity. The treatment of this entity attempts to diminish the muscular hyperfunction by means of different techniques.

Objective and Significance

The aim of this article is to describe the injection technique, as well as showing the outcomes. The injection in the office setting saves the costs of an operating room and alleviates the patients stress associated to a surgical intervention. EMG guidance allows an accurate localization of the muscle with a minimum discomfort for the patient secondary to the needle insertion.

Material and Methods

The non-invasive injection technique of botulinum toxin under electromyography guidance is described thoroughly. We present the management of 3 patients presenting this disorder, accompanied by images before and after the procedure.

Results

Results showed a well-tolerated safe technique, with no complications and optimal results in terms of symptoms amelioration. All patients presented an improvement of the cricopharyngeal dysfunction following the injection with a decrease in the clinical manifestations previously related, without complications related to the procedure.

Conclusions

We confirm the results of previous studies and consider this treatment as an optimal choice in the management of isolated dysfunction of the cricopharyngeal muscle, due to its good tolerance and successful outcomes.
Literature
1.
Ahuja NK, Chan WW (2016) Assessing upper esophageal sphincter function in clinical practice: a primer. Curr Gastroenterol Rep 18(2):7CrossRefPubMed
2.
Shaw SM, Martino R (2013) The normal swallow: muscular and neurophysiological control. Otolaryngol Clin North Am 46(6):937–956CrossRefPubMed
3.
Kocdor P, Siegel ER, Tulunay-Ugur OE (2016) Cricopharyngeal dysfunction: a systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy. Laryngoscope 126(1):135–141CrossRefPubMed
4.
Grishaw EK, Ott DJ, Frederick MG et al (1996) Functional abnormalities of the esophagus: a prospective analysis of radiographic findings relative to age and symptoms. AJR Am J Roentgenol 167(3):719–723CrossRefPubMed
5.
Ho AS, Morzaria S, Damrose EJ (2011) Carbon dioxide laser-assisted endoscopic cricopharyngeal myotomy with primary mucosal closure. Ann Otol Rhinol Laryngol 120:33–39CrossRefPubMed
6.
Ashman A, Dale OT, Baldwin DL (2016) Management of isolated cricopharyngeal dysfunction: systematic review. J Laryngol Otol 130(7):611–615CrossRefPubMed
7.
8.
Schneider I, Thumfart WF, Pototschnig C et al (1994) Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: introduction of a new, noninvasive method. Ann Otol Rhinol Laryngol 103(1):31–35CrossRefPubMed
9.
Kelly EA, Koszewski IJ, Jaradeh SS et al (2013) Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann Otol Rhinol Laryngol 122:100–108CrossRefPubMedPubMedCentral
10.
Alfonsi E, Restivo DA, Cosentino G, De Icco R, Bertino G, Schindler A, Todisco M, Fresia M, Cortese A, Prunetti P, Ramusino MC, Moglia A, Sandrini G, Tassorelli C (2017) Botulinum toxin Is effective in the management of neurogenic dysphagia. Clinical-electrophysiological findings and tips on safety in different neurological disorders. Front Pharmacol 8:80. https://​doi.​org/​10.​3389/​fphar.​2017.​00080CrossRefPubMedPubMedCentral
11.
Wang AY, Kadkade R, Kahrilas PJ et al (2005) Effectiveness of esophageal dilation for symptomatic cricopharyngeal bar. Gastrointest Endosc 61:148–152CrossRefPubMed
12.
Richtsmeier WJ (2003) Endoscopic management of Zenker diverticulum: the staple-assisted approach. Am J Med 115(3):1–4CrossRef
13.
Rabenstein T, May A, Michel J, Manner H, Pech O, Gossner L, Ell C (2007) Argon plasma coagulation for flexible endoscopic Zenker’s diverticulotomy. Endoscopy 39(2):141–145CrossRefPubMed
14.
Zaninotto G, Costantini M, Boccu C et al (1996) Functional and morphological study of the cricopharyngeal muscle in patients with Zenker’s diverticulum. Br J Surg 83(9):1263–1267PubMed
15.
Pitman M, Weissbrod P (2011) Endoscopic cricopharyngeal myotomy. Oper Tech Otolaryngol - Head Neck Surg 22:135–141CrossRef
16.
Burgos R, Sarto B, Segurola H et al (2012) Traducción y validación de la versión en español de la escala EAT-10 (eating assessment tool-10) para el despistaje de la disfagia [translation and validation of the Spanish version of the EAT-10 (eating assessment Tool-10) for the screening of dysphagia]. Nutr Hosp 27(6):2048–2054PubMed
17.
Núñez-Batalla F, Corte-Santos P, Señaris-González B et al (2007) Adaptación y validación del índice de incapacidad vocal (VHI-30) y su versión abreviada (VHI-10) al español [adaptation and validation to the Spanish of the voice handicap index (VHI-30) and its shortened version (VHI-10)]. Acta Otorrinolaringol Esp 58(9):386–392CrossRefPubMed
18.
Calvo-Henríquez C, Ruano-Ravina A, Vaamonde P et al (2019) Translation and validation of the reflux symptom index to Spanish. J Voice 33(5):807.e1-807.e5CrossRefPubMed
19.
Vázquez de la Iglesia F, Fernández González S, de Gómez ML (2007) Reflujo faringolaríngeo: correlación entre los síntomas y los signos mediante cuestionarios de valoración clínica y fibroendoscópica. Es suficiente para realizar el diagnóstico? [laryngopharyngeal reflux: correlation between symptoms and signs by means of clinical assessment questionnaires and fibroendoscopy. Is this sufficient for diagnosis?]. Acta Otorrinolaringol Esp 58(9):421–425CrossRefPubMed
20.
Sivarao DV, Goyal RK (2000) Functional anatomy and physiology of the upper esophageal sphincter. Am J Med 108(4):27S – 37CrossRefPubMed
21.
Haapaniemi JJ, Laurikainen EA, Pulkkinen J et al (2001) Botulinum toxin in the treatment of cricopharyngeal dysphagia. Dysphagia 16(3):171–175CrossRefPubMed
22.
Woisard-Bassols V, Alshehri S, Simonetta-Moreau M (2013) The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness. Eur Arch Otorhinolaryngol 270(3):805–815CrossRefPubMed
Metadata
Title
Botulinum Toxin Injection under Electromyography Guidance for the Treatment of Primary Dysfunction of Cricopharyngeal Muscle
Authors
Beatriz Delgado-Vargas
Leticia Acle-Cervera
Miguel Ángel Saiz Sepúlveda
Blanca Díaz Montoya
Publication date
12-04-2024
Publisher
Springer India
Published in
Journal of Maxillofacial and Oral Surgery
Print ISSN: 0972-8279
Electronic ISSN: 0974-942X
DOI
https://doi.org/10.1007/s12663-024-02173-w