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Zaninotto, G., Marchese Ragona, R., Briani, C., Costantini, M., Rizzetto, C., Portale, G., et al. (2004) The role of botulinum toxin injection and upper esophageal sphincter myotomy in treating oropharyngeal dysphagia. Journal of Gastrointestinal Surgery, 8, 997-1006. http://dx.doi.org/10.1016/j.gassur.2004.09.037

has been cited by the following article:

• TITLE: Botulinum toxin treatment of severe dysphagia following brainstem stroke

  AUTHORS: Domenico De Grandis, Sofia Faletti, Francesco Pirali, Gianna Santus

  KEYWORDS: Deglutition Disorders; Brainstem Stroke; Upper Esophageal Sphincter; Rehabilitation; Botulinum Toxins; Electromyography; Gastrostomy

  JOURNAL NAME: World Journal of Neuroscience, Vol.3 No.4, October 8, 2013

  ABSTRACT: Objective: To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter after first-time brainstem stroke. Design: A retrospective study. Subjects: Twelve patients with long standing dysphagia after brainstem vascular injury admitted to the rehabilitation department of a medical centre. Methods: All patients underwent clinical examination, videofluoroscopic study of swallowing and electromyography. Botulinum toxin was injected percutaneously under electromyographic guide. Outcomes were measured after two weeks and through a long follow up programme, which ranged from two to ten years. Results: A total of 75% of patients (9 of 12) had favourable outcomes. Two patients showed long lasting functional benefits after only one botulinum toxin injection, while seven patients required further treatments to maintain an adequate oral intake. In seven cases it was possible to remove percutaneous endoscopic gastrostomy. No relevant complications were observed. Conclusion: Botulinum toxin can improve severe dysphagia with elective hyperactivity of the upper esophageal sphincter in patients with or without unilateral paresis of the inferior constrictor muscle and in absence of a nuclear involvement of the IXth and Xth cranial nerves. The outcome could be unsatisfactory in the cases of oral phase involvement, bilateral lesion of the inferior constrictor muscle and when there is velopharyngeal insufficiency.