Low Dose Botulinum Toxin Injection in Retrograde Cricopharyngeal Dysfunction

Area of Science:

• Otolaryngology
• Gastroenterology
• Neurology

Background:

• Retrograde cricopharyngeal dysfunction (R-CPD) presents with symptoms like inability to belch.
• Standard examinations often show no abnormalities in R-CPD patients.
• Botulinum toxin injection is a common treatment for R-CPD.

Purpose of the Study:

• To evaluate the effectiveness of low-dose botulinum toxin injections for R-CPD.
• To assess outcomes in patients with inability to belch treated with botulinum toxin.

Main Methods:

• Retrospective case series of 3 consecutive R-CPD patients.
• Botulinum toxin injected into the cricopharyngeal muscle at doses of 12.5-17.5 units.
• Clinical swallowing evaluations performed by speech-language pathologists.

Main Results:

• All 3 patients experienced symptomatic improvement after low-dose botulinum toxin injection.
• Two patients required revision surgery for sustained improvement.
• No intraoperative or postoperative complications were reported.
• Swallowing evaluations revealed neck muscle hypertonia and weak tongue strength in 2 patients.

Conclusions:

• Low-dose botulinum toxin injection is an effective, albeit unpredictable, treatment for R-CPD.
• While symptom improvement occurred in all cases, some patients needed further intervention.
• The findings highlight the potential of targeted botulinum toxin therapy for R-CPD.