Journal of the Korean Dysphagia Society 2016;6(1):42-47

Combination Technique with Ultrasonography and Electromyography for Botulinum Injection in the Cricopharyngeal Muscle: A Case Report.

Sang Eok LEE 1 ; Byung Hee KIM ; Hee Jung SIM ; Jin Hee HEO ; Seok Il SON ; Min Sol KIM ; Seong Hye HWANG ; Hyo Jung KIM

Affiliations

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Keywords

Cricopharyngeal dysfunction; Botulium toxins; Ultrasonography; Electromyography; Dysphagia

Country

Republic of Korea

Language

Korean

Abstract

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.