The role of botulinum toxin injection and upper esophageal sphincter myotomy in treating oropharyngeal dysphagia

Efficacy of large-diameter dilatation in cricopharyngeal dysfunction

“…This serves two purposes: 1) if the dysphagia resolves, the patient can avoid a more morbid myotomy procedure; and 2) if the patient experiences no relief of symptoms, it can suggest a search for other causes of the dysphagia. This is similar to the diagnostic utility of botulinum toxin injection as suggested by Zaninotto et al 15 However, CP dilatation may be a more useful diagnostic tool, because histologic evidence suggests that fibrosis of the cricopharyngeus could be at fault in at least some cases of CPD. 16 In this scenario, a botulinum toxin injection test would be more likely to be falsely negative.…”

Late esophageal toxicity after radiation therapy for head and neck cancer

“…Although the effect of subsequent treatment for stricture was not formally evaluated in this study, others have demonstrated that procedures such as myotomy and botulinum injection are effective in improving the symptoms and the quality of life. [27][28][29] It must be recognized that essentially all patients who were unable to swallow solids at 2 to 3 months after radiation therapy were referred for consideration of immediate esophagoscopy and dilatation at our institution during the time period of this study. This policy may have contributed to a higher observed incidence of esophageal pathology including stricture than reported by others.…”

High Dose of Botulinum Toxin Type A (NT-201) for the Treatment of Dysphagia due to Severe Spasticity of Upper Oesophageal Sphincter: A Case Report

“…It is possible that not all patients suffering from severe dysphagia could have benefit by high BoNT-A dosage. Zaninotto et al [10] suggested that the best candidates to BoNT-A treatment are the subjects showing less severely damaged swallowing function at VS and CP spasm still capable of propelling the bolus through the mouth and pharynx [10]. Anyway, in treating dysphagia by BoNT-A agent, whenever common doses fail, we suggest to use high dosage of neurotoxin before proposing other therapeutic strategies.…”

“…Although BoNT-A could represent an alternative therapeutic strategy to the surgical option, the dysphagia could be unchanged by neurotoxin treatment. Zaninotto et al [10] reported that BoNT-A was effective in only 40% of subjects with dysphagia following various diseases [10]. Several reasons could explain negative results as such neurotoxin formulation, dilutions, variability of points of injections from single or multiple shots, and variability in the delivery techniques.…”