Lateral Transcervical In‐office Botulinum Toxin Injection for Retrograde Cricopharyngeal Dysfunction

Abstract

ObjectiveOperating room (OR) injection of botulinum toxin (BTX) injection is effective in the management of retrograde cricopharyngeal dysfunction (RCPD). This study aims to analyze the efficacy and safety of in‐office (IO) 30 Unit BTX injection into the cricopharyngeus via lateral transcervical approach.MethodsA retrospective chart review of patients who underwent BTX injection either in the OR or IO for RCPD was performed. Postoperative success, defined by patient‐reported complete or near complete resolution of symptoms, side effects, and complication rates of each group was determined and compared. To determine the learning curve of IO injections, success rates of the injections performed in the early and late 6 months were compared. Chi‐square test was used for determining the statistical significance.ResultsOverall, 78 injections (37 IO and 41 OR) for RCPD were performed by the senior author. The success rate of OR injections (90.2%) is significantly higher than IO injections (64.9%) at the first‐month follow‐up (p = 0.022). No significant difference was found in the side effect rates. Success and side effect rates were also similar in early and late injections (p > 0.05).ConclusionsIO lateral transcervical BTX injection for RCPD is a safe method that does not require general or topical anesthesia. While the side effects are similar and IO injections have many advantages, the success rates are lower than OR injections.Level of Evidence3 Laryngoscope, 2023

Retrograde Cricopharyngeus Dysfunction effectively treated with low dose botulinum toxin. A case report from Italy

“…Only very recently, a retrospective study by Doruk and Pitman ( 12 ) showed that injection of a lower 30 units dose of BT, unilaterally injected into the cricopharyngeus muscle in 3 different spots, could be highly effective and safe.…”

“…This method proven to be very accurate, can be easily performed in an outpatient setting, and limits possible complications due to general anesthesia. Doruk and Pitman ( 12 ) used a transcervical lateral approach for unilateral BT injection in an outpatient setting, showing a lower success rate than operating room injection but a better safety and tolerability profile. Recently, Xie ( 10 ) described an innovative method for the injection of botulinum toxin into the cricopharyngeus muscle under ultrasound, catheter balloon, and electromyographic guidance.…”

“…Sometimes the patients themselves, driven by the persistence and severity of the symptoms, may get to guess the diagnosis while looking for information on the internet or obtaining clues from online patients' communities. Based on the available literature, the treatment of R-CPD consists in the injection of 30 -100 units of onabotulinum toxin into the cricopharyngeus muscle (that represents the main portion of the Upper Esophageal Sphincter, UES) under local or general anesthesia (5)(6)(7)(8)(9)(10)(11)(12). According to medium-term data published so far (6-8, 11, 12), the BT is effective in most subjects, often with prolonged therapeutic effects, lasting much longer than expected when treating other muscle districts.…”

“…Based on the available literature, the treatment of R-CPD consists in the injection of 30 –100 units of onabotulinum toxin into the cricopharyngeus muscle (that represents the main portion of the Upper Esophageal Sphincter, UES) under local or general anesthesia ( 5–12 ). According to medium-term data published so far ( 6–8 , 11 , 12 ), the BT is effective in most subjects, often with prolonged therapeutic effects, lasting much longer than expected when treating other muscle districts. Here we describe the first case of R-CPD diagnosed in Italy, successfully treated with unilateral, anesthesia-free injection of 10 units of onabotulinum toxin-A into the cricopharyngeus muscle, representing the lowest dose reported to date.…”

Retrograde Cricopharyngeal Dysfunction: A Review

“…Botulinum toxin injections into the CP are the mainstay of RCPD treatment. Currently, there is no uniform dosing protocol, and therefore, treating physicians have their own preferences for injection technique and dosing [8,22,23,27]. A study on the long-term efficacy of the first 200 patients with RCPD treated with botulinum toxin injections revealed that 95% of patients experienced relief of the cardinal symptoms of RCPD, and about 80% of those patients had durable resolution in their symptoms at 6 months post-treatment [22].…”