Endoscopic Botulinum Toxin Injection for the Treatment of Dysphagia Caused by Cricopharyngeal Hypertonicity : A case report

ABSTRACT

Hypertonicity of the cricopharyngeal muscle often results in dysphagia. Current available treatments for this problem include the mechanical balloon dilation and cricopharyngeal myotomy. Recently, a botulinum toxin injection into the cricopharyngeal muscle has been proved to be a successful approach. The case well proved the effectiveness of botulinum toxin injections as a viable treatment for patients suffering from cricopharyngeal dysphagia. A 58 year-old man, who had right lateral medullary infarction, claimed severe difficulties in swallowing which was complicated by aspiration pneumonia. A videofluoroscopic barium swallow test indicated aspiration and cricopharyngeal hypertonicity. Botulinum toxin was injected into the cricopharyngeal muscle, through endoscopic identification. After treatment, videofluoroscopy showed a significant improvement in the cricopharyngeal muscle opening and no more silent aspiration was seen. This case implicated the effectiveness of endoscopic botulinum toxin injection treatment for cricopharyngeal dysphagia in situations where there was no response to traditional swallowing rehabilitation.