Ann Rehabil Med.  2018 Apr;42(2):358-362. 10.5535/arm.2018.42.2.358.

Botulinum Toxin Injection in the Treatment of Postextubation Dysphagia: A Case Report

• Kim BW
• Kim HJ
• Hyun JK
• Kim SY
• Kim TU

• KMID: 2432208
• DOI: http://doi.org/10.5535/arm.2018.42.2.358

Abstract

Prolonged intubation is known to bring on postextubation dysphagia (PED) in some patients. We have noted that there were some studies to investigate specific type and pattern of PED, which showed large variety of different swallowing abnormalities as mechanisms of PED that are multifactorial. There are several options of treatment in accordance with the management of these abnormalities. A botulinum toxin (BoT) injection into the upper esophageal sphincter (UES) can improve swallowing functions for patients with this disorder, by working to help the muscle relax. In this case, the conventional treatment was not effective in patients with PED, whereas the BoT injection made a great improvement for these patients. This study suggests that the UES pathology could be the main cause of PED.

Keyword

Deglutition disorders; Endotracheal intubation; Botulinum toxin

MeSH Terms

Botulinum Toxins*
Deglutition
Deglutition Disorders*
Esophageal Sphincter, Upper
Humans
Intubation
Intubation, Intratracheal
Pathology
Botulinum Toxins

Figure

• 

  Fig. 1 (A) Before the botulinum toxin injection, inappropriate relaxation of upper esophageal sphincter and massive aspiration is shown. (B) After the botulinum toxin injection, laryngeal elevation and relaxation of upper esophageal sphincter were significantly enhanced. The patient adopted chin tuck posture.

• 

  Fig. 2 The asterisks indicate the two injection sites of upper esophageal sphincter on laryngoscopy.

Reference

1. Rassameehiran S, Klomjit S, Mankongpaisarnrung C, Rakvit A. Postextubation dysphagia. Proc (Bayl Univ Med Cent). 2015; 28:18–20. PMID: 25552788.

2. Bishop MJ, Weymuller EA, Fink BR. Laryngeal effects of prolonged intubation. Anesth Analg. 1984; 63:335–342. PMID: 6367543.

3. Barker J, Martino R, Reichardt B, Hickey EJ, Ralph-Edwards A. Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery. Can J Surg. 2009; 52:119–124. PMID: 19399206.

4. Partik B, Pokieser P, Schima W, Schober E, Stadler A, Eisenhuber E, et al. Videofluoroscopy of swallowing in symptomatic patients who have undergone long-term intubation. AJR Am J Roentgenol. 2000; 174:1409–1412. PMID: 10789804.

5. Alfonsi E, Merlo IM, Ponzio M, Montomoli C, Tassorelli C, Biancardi C, et al. An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment. J Neurol Neurosurg Psychiatry. 2010; 81:54–60. PMID: 19762326.

6. Woisard-Bassols V, Alshehri S, Simonetta-Moreau M. The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness. Eur Arch Otorhinolaryngol. 2013; 270:805–815. PMID: 22865104.

7. Goldsmith T. Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin. 2000; 38:219–242. PMID: 10984854.

8. O'Leary MA, Grillone GA. Injection laryngoplasty. Otolaryngol Clin North Am. 2006; 39:43–54. PMID: 16469654.

9. Kocdor P, Siegel ER, Tulunay-Ugur OE. Cricopharyngeal dysfunction: a systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy. Laryngoscope. 2016; 126:135–141. PMID: 26360122.

10. Spataro EA, Grindler DJ, Paniello RC. Etiology and time to presentation of unilateral vocal fold paralysis. Otolaryngol Head Neck Surg. 2014; 151:286–293. PMID: 24796331.