Botulinum toxin for oropharyngeal dysphagia: case report of flexible endoscope-guided injection

Botulinnm toxin (BT) has been used in neurology, ophthalmology, otorhinolar yngology and gastroenterology. Twenty-four patients with oropharyngeal dysp hagia treated with BT injection into the cricopharyngeal muscle were report ed, with good results in up to 79% of the patients, Different techniques we re used to inject BT: percutaneous (guided by electromyography, computed to mography or videofluoroscopy) or direct injection during esophagoscopy (wit h a rigid esophagoscope), We report the first case of oropharyngeal dysphag ia treated by BT injection into the cricopharyngeal muscle using a flexible scope, with clinical, radiological and manometric improvement. A reduction in the disability score 4 to 2 and sustained capacity to mainta in adequate oral caloric intake were observed. The patient was also able to have the tracheotomy orifice closed and the gastrostomy tube removed after 3 months, Manometry showed a 38% reduction in the upper esophageal sphinct er pressure with the presence of pharyngeal waves that were previously abse nt. After 1 year of follow-up, the patient was in good condition with mild dysphagia for solid foods. This is another case of complex dysphagia and re lative hyperfunction of the cricopharyngeal muscle successfully treated wit h BT injection.