Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Chapter 1 The pretherapeutic history of botulinum neurotoxin
- Chapter 2 Botulinum neurotoxin: history of clinical development
- Chapter 3 Pharmacology of botulinum neurotoxins
- Chapter 4 Immunological properties of botulinum neurotoxins
- Chapter 5 Treatment of cervical dystonia
- Chapter 6 Examination and treatment of complex cervical dystonia
- Chapter 7 Ultrasound guidance for botulinum neurotoxin therapy: cervical dystonia
- Chapter 8 Treatment of blepharospasm
- Chapter 9 Botulinum neurotoxin in oromandibular dystonia
- Chapter 10 Treatment of focal hand dystonia
- Chapter 11 Botulinum neurotoxin therapy of laryngeal muscle hyperactivity syndromes
- Chapter 12 The use of botulinum neurotoxin in otorhinolaryngology
- Chapter 13 Treatment of hemifacial spasm
- Chapter 14 Spasticity
- Chapter 15 The use of botulinum neurotoxin in spastic infantile cerebral palsy
- Chapter 16 The role of ultrasound for botulinum neurotoxin injection in childhood spasticity
- Chapter 17 The use of botulinum neurotoxin in spasticity using ultrasound guidance
- Chapter 18 The use of botulinum neurotoxin in tic disorders and essential hand and head tremor
- Chapter 19 Treatment of stiff-person syndrome with botulinum neurotoxin
- Chapter 20 Botulinum neurotoxin applications in ophthalmology
- Chapter 21 Cosmetic uses of botulinum neurotoxins
- Chapter 22 Hyperhidrosis
- Chapter 23 Botulinum neurotoxin A treatment for ischemic digits
- Chapter 24 Botulinum neurotoxin in wound healing
- Chapter 25 Use of botulinum neurotoxin in neuropathic pain
- Chapter 26 The use of botulinum neurotoxin in the management of headache disorders
- Chapter 27 The use of botulinum neurotoxin in musculoskeletal pain and arthritis
- Chapter 28 Treatment of plantar fasciitis with botulinum neurotoxins
- Chapter 29 Use of botulinum neurotoxin in the treatment of low-back pain
- Chapter 30 Use of botulinum neurotoxin in the treatment of piriformis syndrome
- Chapter 31 Ultrasound-guided botulinum neurotoxin injections for thoracic outlet syndrome
- Chapter 32 Botulinum neurotoxin in the gastrointestinal tract
- Chapter 33 Botulinum neurotoxin applications in urological disorders
- Index
- References
Chapter 32 - Botulinum neurotoxin in the gastrointestinal tract
Published online by Cambridge University Press: 05 February 2014
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Chapter 1 The pretherapeutic history of botulinum neurotoxin
- Chapter 2 Botulinum neurotoxin: history of clinical development
- Chapter 3 Pharmacology of botulinum neurotoxins
- Chapter 4 Immunological properties of botulinum neurotoxins
- Chapter 5 Treatment of cervical dystonia
- Chapter 6 Examination and treatment of complex cervical dystonia
- Chapter 7 Ultrasound guidance for botulinum neurotoxin therapy: cervical dystonia
- Chapter 8 Treatment of blepharospasm
- Chapter 9 Botulinum neurotoxin in oromandibular dystonia
- Chapter 10 Treatment of focal hand dystonia
- Chapter 11 Botulinum neurotoxin therapy of laryngeal muscle hyperactivity syndromes
- Chapter 12 The use of botulinum neurotoxin in otorhinolaryngology
- Chapter 13 Treatment of hemifacial spasm
- Chapter 14 Spasticity
- Chapter 15 The use of botulinum neurotoxin in spastic infantile cerebral palsy
- Chapter 16 The role of ultrasound for botulinum neurotoxin injection in childhood spasticity
- Chapter 17 The use of botulinum neurotoxin in spasticity using ultrasound guidance
- Chapter 18 The use of botulinum neurotoxin in tic disorders and essential hand and head tremor
- Chapter 19 Treatment of stiff-person syndrome with botulinum neurotoxin
- Chapter 20 Botulinum neurotoxin applications in ophthalmology
- Chapter 21 Cosmetic uses of botulinum neurotoxins
- Chapter 22 Hyperhidrosis
- Chapter 23 Botulinum neurotoxin A treatment for ischemic digits
- Chapter 24 Botulinum neurotoxin in wound healing
- Chapter 25 Use of botulinum neurotoxin in neuropathic pain
- Chapter 26 The use of botulinum neurotoxin in the management of headache disorders
- Chapter 27 The use of botulinum neurotoxin in musculoskeletal pain and arthritis
- Chapter 28 Treatment of plantar fasciitis with botulinum neurotoxins
- Chapter 29 Use of botulinum neurotoxin in the treatment of low-back pain
- Chapter 30 Use of botulinum neurotoxin in the treatment of piriformis syndrome
- Chapter 31 Ultrasound-guided botulinum neurotoxin injections for thoracic outlet syndrome
- Chapter 32 Botulinum neurotoxin in the gastrointestinal tract
- Chapter 33 Botulinum neurotoxin applications in urological disorders
- Index
- References
Summary
Cricopharyngeal dysphagia
The cricopharyngeal muscle, or upper esophageal sphincter (UES), corresponds to the most inferior portion of the inferior constrictor muscle. It creates a sphincter separating the hypopharynx from the esophagus, preventing the inlet of air into the esophagus during inspiration and esophageal reflux into the pharynx. It is myoelectrically silent at rest and active during swallowing.
Cricopharyngeal dysphagia arises from dysfunction of the cricopharyngeal muscle, which can be primary or secondary to a number of pathological conditions, including cerebrovascular accidents, amyotrophic lateral sclerosis, oculopharyngeal muscular dystrophy and skull basal lesion. Oropharyngeal dysphagia is the clinical presentation and possibly correlates with aspiration or penetration of liquid or food into the upper airways. During manometry, incomplete relaxation of the UES or an increase in intrabolus pressure may be demonstrated (Fig. 32.1).
Cricopharyngealmuscle dysfunction has been traditionally treated with surgical myotomy, mechanical dilatation or plexus neurectomy. Localized injections of botulinum neurotoxin (BoNT) into the dorsomedial or ventrolateral parts of the muscle have also been successfully performed endoscopically, percutaneously (Fig. 32.1a) and eventually under CT or fluoroscopic control, with or without electromyographic (EMG) guidance (Fulmer et al., 2011). Unfortunately, there are no standards or guidelines and the administered dose reported ranges widely between 10 and 120 U onabotulinumtoxinA, usually selected on the basis of symptom severity.
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- Manual of Botulinum Toxin Therapy , pp. 278 - 287Publisher: Cambridge University PressPrint publication year: 2014