Botulinum toxin for cricopharyngeal
dysfunction in Parkinson's disease.
Foreign bodies get lodged in any of the three narrow points in the oesophagus: the cricopharyngeal
area, the middle third of the oesophagus where the aortic arch and left main bronchus cross the oesophagus or the lower oesophageal sphincter.
Decreased pharyngeal peristalsis and cricopharyngeal
relaxation were noted.
Given the inability to find the nerve in its usual location and after assessing the anatomical landmarks used to this effect, the retrograde dissection is useful, i.e., from the entrance of the nerve to the larynx below the fascicles of the cricopharyngeal
portion of the inferior constrictor, always taking the possibility of its extralaryngeal division into consideration (Ngo Nyeki et al.).
Other potential etiologies for this symptom include gastroesophageal reflux disease, postnasal drip, cricopharyngeal
spasm, lingual tonsil hypertrophy, cervical osteophytes, and malignancy [5, 6].
The various mechanisms of dysphagia are mechanical compression causing esophageal obstruction, pharyngoesophageal irritation, and a local inflammatory response resulting in cricopharyngeal
spasm and esophageal denervation .
The transport of bolus into the esophagus depends to a greater extent on the coordination between cricopharyngeal
muscles, UES, and upper esophagus (10,11).
The sharp metal parts of the tooth were lodged in the cricopharyngeal
Usually, the foreign bodies are stuck at an inch below the cricopharyngeal
sphincter because strong propulsive pharyngeal muscles can force an object up to that level and further down the oesophageal musculature cannot propel the foreign body with the same intensity.
Messner, "The use of botulinum toxin for pediatric cricopharyngeal
achalasia," International Journal of Pediatric Otorhinolaryngology, vol.
Upper endoscopy revealed multiple large hypervascularized violaceous submucosal nodular lesions with stigmata of recent bleeding on the soft palate and pharynx and within the cricopharyngeal
area close to the vocal cords.
The role of fibrin sealants throughout surgery is expanding and the use of fibrin has been described to line the repair of cricopharyngeal
myotomy and in tracheal lacerations [9, 10].