Botulinum toxin in the treatment of cricopharyngeal dysphagia

Dysphagia is a common symptom in various neurological disorders affecting p haryngeal functions. Cricopharyngeal dysfunction is one of the major findin gs in these patients. The most effective treatment for restoring normal swa llowing function in persistent cricopharyngeal dysfunction is cricopharynge al myotomy, especially when mechanical obstruction or a well-localized neur omuscular dysfunction, such as a cricopharyngeal muscle spasm, is present. However, when there is a more diffuse neurological disorder present the res ults of surgery are more disappointing. In unclear cases, or in patients wi th temporary problems, no good method other than swallowing training, bougi enage, and tube feeding are available. During the past decade, botulinum to xin has been found to be of therapeutic value in the treatment of a variety of neurological disorders associated with inappropriate muscular contracti ons such as torticollis and spasmodic dysphonia. Recently, injections of bo tulinum toxin in patients with cricopharyngeal muscle dysfunction have been reported to result in marked relief of dysphagia. In this: article we desc ribe our experiences with botulinum toxin injections: to treat four patient s suffering from deglutition problems and cricopharyngeal dysphagia of diff erent origins. Botulinum toxin was injected into the cricopharyngeus muscle that was identified by endoscopy under general anesthesia. In this study, no major side effects were observed. Three patients obtained a significant improvement of esophageal symptoms after the first injection. The treatment had limited effect in one patient who had reflux disease and only slight c ricopharyngeus dysfunction.