ABSTRACT
Objective:To analyze the factors related to rehabilitation outcome of dysphagia for patients with cricopharyngeal dysfunction. Methods:From October, 2017 to December, 2020, 16 inpatients with cricopharyngeal dysfunction in Beijing Bo'ai Hospital accepted swallowing training and balloon dilatation. They also finished Shaker exercise out of treatment rooms, and the compliance was recorded. They were assessed with Ichiro Fujishima's Ingestion-Swallowing Function Rating Scale, and divided into effective and ineffective groups according to the result of assessment. The factors such as ages, education levels, courses of disease, time of treatment, compliance, balloon dilation modes, balloon dilation times and maximum water capacity of the balloon were recorded. Results:The score of swallowing improved after treatment (Z = -3.550, P < 0.001). There were significant differences between groups in age (Z = 0.833, P = 0.031) and compliance (P = 0.003). Age negatively correlated with effect (r = -0.533, P = 0.033), and compliance positively correlated (r = 0.856, P < 0.001). Conclusion:Age and compliance to rehabilitation relate to the outcome of dysphagia for patients with cricopharyngeal dysfunction. It is more effective in patients with good compliance and younger age.
ABSTRACT
Cricopharyngeus muscle (CPM) is an important component of upper esophageal sphincter. It is termed cricopharyngeus dysfunction (CPD) if CPM fails to relax, which may be second to neurologic or neoplastic disease. However, the pathogenesis is not yet clear. The diagnosis of CPD would combine clinical features and swallowing evalutions, such as videofluoroscopic swallowing study, pharyngeal manometry and electromyogram, etc. Esophageal manometry is not the golden standard and should be combined with videofluoroscopic swallowing study. Interventions include swallowing exercise, pharyngoesophageal balloon dilatation, Botulinum toxin injection and cricopharyngeus myotomy. The outcomes will be better in those with intact laryngeal elevation and pharyngeal contraction. Balloon dilation is more commonly used. The success rate of cricopharyngeus myotomy is reported higher than that of Botulinum toxin injection. Each of the three technologies has their advantages, and it needs more researches to study their indications, contraindications and patient selection.
ABSTRACT
[Objective] To investigate the feasibility and effectiveness of using ultrasound-guided cricopharyngeal (CP) botulinum toxin (BTX) injection to treat cricopharyngeal dysfunction after brainstem infarction.[Method] A patient with dysphagia caused by subacute lacunar infarction in the right pontobulbar junction was diagnosed with incomplete opening of cricopharyngeal muscle by videofluoroscopic swallowing study (VFSS).After precisely locating the CP muscle with catheter balloon and ultrasound,we injected BTX (25 U/0.8 mL) into the left CP muscle using the out-of-plane approach technique.[Result] After the injection,the patient made great progress in swallowing.He was able to eat porridge independently without bucking on the 5th day,while soft rice on the 8th day and sip water.Two weeks after the injection,VFSS showed that the bolus progressed into the esophagus fluently without the route getting narrow or broken off,and hardly found residue in pharynx,which suggested that the CP muscle could open properly.[Conclusion] Cricopharyngeal injection of BTX guided by ultrasound is a safe and effective way to treat cricopharyngeal dysfunction after brainstem infarction,which is also convenient to operate and deserves to be disseminated after the further studies proves its effectiveness.
ABSTRACT
OBJECTIVE: To investigate changes of swallowing function after ballooning dilatation (BD) and the Botox injection (BI) into the cricopharyngeus muscle in patients with severe dysphagia. METHOD: Nine severe dysphagic patients with cricopharyngeal dysfunction (CPD) who underwent BD and/or BI into the cricopharyngeal muscle were retrospectively reviewd. Patients who had severe dysphagia (Functional Oral Intake Scale (FOIS)≤2) after at least 3 months of the conventional swallowing therapy were included by a thorough review of medical records with videofluoroscopic swallowing study (VFSS). Before and after several interventions (BD and/or BI), swallowing function was evaluated using VFSS. RESULT: Among 9 patients, 5 underwent both BD and BI, and the other 4 patients underwent only BD. Four among 9 cases showed that interventions were effective. Of the 5 cases with both BD and BI, 2 cases were effective for treatment of CPD. In all the effective 4 cases, pyriform sinus residue seemed to be related with FOIS. Of those cases, one case had long-term effect (more than 4 months) and the other 3 case had short term effect (less than 4 months). CONCLUSION: Interventions were effective in 4 among 9 cases with severe CPD and the therapeutic effect was sustained for more than 4 months. The results suggest that in CPD patients, the BD or BI into UES could be considered in selected patients.
Subject(s)
Humans , Botulinum Toxins , Deglutition , Deglutition Disorders , Dilatation , Fluoroscopy , Medical Records , Methods , Pharyngeal Muscles , Pyriform Sinus , Retrospective StudiesABSTRACT
La miotomía cricofaríngea es una técnica quirúrgica introducida hace años para el tratamiento de la disfagia asociada a disfunción del músculo cricofaríngeo con o sin divertículo de Zenker, mostrando resultados exitosos que revierten la sintomatologta y mejoran la calidad de vida del paciente. Con los avances científicos surge la cirugía láser endoscópica que permite ser una alternativa quirúrgica segura, viable y efectiva respecto a la miotomía clásica abierta, según diferentes series publicadas, mostrando disminuir los tiempos de anestesia, quirúrgico y de recuperación. En este artículo describimos un caso clínico, la técnica quirúrgica utilizada y los resultados en un paciente con disfagia por disfunción cricofaríngea con buen resultado posoperatorio.
Cricopharyngeal myotomy is a surgical technique introduced years ago for the treatment of dysphagia associated with cricopharyngeal muscle dysfunction with or without Zenker’s diverticulum, showing successful results that reverse the symptoms and improve the quality of life of patients. With scientific advances endoscopic laser surgery allows to be an open safe, feasible and effective for classical surgical myotomy alternative, according to various published series showing decreasing times anesthesia, surgical and recovery emerges. In this article we describe a case, the surgical technique used and results in a patient with dysphagia by cricopharyngeal dysfunction with good postoperative outcome.
Subject(s)
Humans , Female , Aged , Pharyngeal Muscles/surgery , Deglutition Disorders/surgery , Endoscopy , Lasers, Gas/therapeutic use , Treatment OutcomeABSTRACT
Cricopharygeal dysfunction (CPD) may lead to a range of symptoms including dysphagia and aspiration. Treatments for CPD have included mechanical dilation, myotomy and botulinum injection. Recently, the use of botulinum toxin injection has been reported to be safe and effective for the treatment of CPD. Ultrasonography guided technique, however, is not well established. A 55-year-old woman visited the hospital with a left cerebellar, lateral medullary, and pons infarct 4 years ago. A three-year conventional dysphagia therapy had not improved the patient's condition. Nutrition had been provided via a percutaneous endoscopic gastrostomy (PEG) tube. Videofluoroscopic swallowing study (VFSS) showed CPD. Ultrasonography and elelctromyography-guided injection of 20 units of botulinum (Meditoxin®) in left cricopharyngeal muscle. One month after injection, the VFSS showed improvement in relaxation of the upper esophageal sphincter. The patient could eat semisolid food and a soft diet at 1,200 kcal/day orally; the treatment was a success.
Subject(s)
Female , Humans , Middle Aged , Botulinum Toxins , Deglutition , Deglutition Disorders , Diet , Electromyography , Esophageal Sphincter, Upper , Gastrostomy , Pons , Relaxation , UltrasonographyABSTRACT
OBJECTIVE: To evaluate an effect of balloon catheter dilatation on post-swallow laryngeal elevation, total pharyngeal transit time and pharyngeal remnant in stroke patients with cricopharyngeal dysfunction. METHOD: The 20 stroke patients with cricopharyngeal dysfunction in videofluoroscopic swallow study were recruited for the study. Using 16 Fr foley catheter, balloon was positioned across the upper esophageal sphincter under video-fluoroscopy. Balloon catheter dilatation was done for 3 minutes and each ballooning was repeated 6 times for a minute. We compared pre-balloon dilatation and post-balloon dilatation values. 3 factors were evaluated, which were laryngeal elevation, total pharyngeal transit time, and post-swallow pharyngeal remnant. RESULTS: There was no significant difference in laryngeal elevation after balloon dilatation. However, total pharyngeal transit time (p<0.01) and pharyngeal remnant (p<0.001) were significantly reduced after balloon dilatation. CONCLUSION: There were significant decrements of post-swallow total pharyngeal transit time and pharyngeal remnant after balloon dilation procedure. Balloon dilation of upper esophageal sphincter can produce relief of dysphagia in stroke patients with cricopharyngeal dysfunction.
Subject(s)
Humans , Catheters , Deglutition , Deglutition Disorders , Dilatation , Esophageal Sphincter, Upper , StrokeABSTRACT
Primary cricopharyngeal dysfunction is a rare, idiopathic, functional disorder of the upper esophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and functional narrowing at the level of UES. It is caused by failure or partial relaxation of the sphincter, lack of pharyngoesophageal coordination, or reduced compliance of the muscular of the UES. We saw a 62-year-old man who presented with dysphagia and UES narrowing on videofluoroscopy swallowing study (VFSS). Physical, neurologic, and laboratory evaluations revealed no abnormal findings. Radiologic evaluation looking for any abnormalities that might provoke dysphagia was within normal limits. VFSS showed laryngeal aspiration, residue in vallecular and pyriform sinuses, and cricopharyngeal narrowing. Balloon catheter dilatation under endoscopic guidance was performed twice, after which, the dysphagia improved. Here, we describe the results of treatment with balloon dilatation in a patient with primary cricopharyngeal dysfunction.