TREATMENT OF DYSFUNCTION OF THE CRICOPHARYNGEAL MUSCLE WITH BOTULINUM A TOXIN - INTRODUCTION OF A NEW, NONINVASIVE METHOD
TREATMENT OF DYSFUNCTION OF THE CRICOPHARYNGEAL MUSCLE WITH BOTULINUM A TOXIN - INTRODUCTION OF A NEW, NONINVASIVE METHOD
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DOI：
10.1177/000348949410300105
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发表时间：
1994-01-01
影响因子：
1.4
通讯作者：
ECKEL, HE
中科院分区：
文献类型：
--
作者：
SCHNEIDER, I;POTOTSCHNIG, C;ECKEL, HE
肉毒杆菌毒素是一种相对安全和有效的药物，用于治疗各种神经和眼科疾病。由于吞咽困难和吞咽问题与误吸往往是由痉挛，张力过高，或延迟松弛的上食管括约肌（UES），传统的治疗，包括外侧crcraniopharyngotomy取代局部注射肉毒杆菌毒素到craniopharyngotomy（CM）在一系列的7名患者。该研究包括由UES的孤立性高张力引起的轻度吞咽困难的患者，以及患有严重吞咽障碍、完全无法吞咽和误吸问题的患者。术前诊断评估包括仔细的病史采集、体格检查、放射性电影摄影和食管测压，以排除吞咽困难的其他原因。为了精确定位，在通过直接食管镜检查和肌电图引导定位CM后，在全身麻醉下进行注射。在背内侧部分和两侧肌肉腹外侧垫进行注射。根据症状的严重程度和UES的管腔内压力，剂量在80和120单位之间变化（来自Dysport的肉毒杆菌毒素A）。通过残疾评分评估治疗结果：通过注射前后的主观和客观参数对患者的主诉进行评分。除2例患者外，所有患者的主诉均完全缓解或显著改善。无严重副作用和术后并发症。局部肉毒杆菌毒素注射被证明是一种有效的替代治疗侵入性手术的患者孤立的功能障碍的UES，也为患者更复杂的吞咽问题合并误吸。
Botulinum toxin is known as a relatively safe and efficacious agent for the treatment of various neurologic and ophthalmologic disorders. Since dysphagia and deglutition problems combined with aspiration are often caused by spasticity, hypertonus, or delayed relaxation of the upper esophageal sphincter (UES), conventional treatment including lateral cricopharyngotomy was replaced by localized injections of botulinum toxin into the cricopharyngeal muscle (CM) in a series of 7 patients. The study comprised patients with slight dysphagia caused by isolated hypertonus of the UES, as well as patients with severe deglutition disorders, complete inability to swallow, and aspiration problems. Preoperative diagnostic evaluation included careful history-taking, physical examination, cineradiography, and esophageal manometry to exclude other causes of dysphagia. For precise localization, injections were performed under general anesthesia after location of the CM by direct esophagoscopy and electromyographic guidance. Injections were administered into the dorsomedial part and on both sides into the ventrolateral pads of the muscle. Depending on the severity of symptoms and the intraluminal pressure of the UES, the dose varied between 80 and 120 units botulinum toxin A from Dysport). The treatment outcome was evaluated by a disability rating score: patients' complaints were scored by subjective and objective parameters before and after injection. All but 2 patients experienced complete relief or marked improvement of their complaints. There were no severe side effects or postoperative complications. Local botulinum toxin injection proved to be an effective alternative treatment to invasive procedures for patients with isolated dysfunction of the UES, and also for patients with more complex deglutition problems combined with aspiration.