Solely Ultrasound-guided Botulinum Toxin Injection in the Cricopharyngeus Muscle: Successful Treatment in a Patient of Chronic Dysphagia Following Lateral Medullary Syndrome

Botulinum toxin (BTX) injection is a widely used procedure for the treatment of the dysfunction of the upper oesophageal sphincter. Although injection can be guided by ultrasound (US), electromyography or computed tomography, the most convenient option will be solely US-guided injection. No studies yet observed the effectiveness of solely US-guided BTX injection in the cricopharyngeus muscle (CPM) in dysphagia following lateral medullary syndrome (LMS). In this report, 50 U of BTX type-A was given in the right CPM in a patient of right LMS with chronic severe dysphagia, under the guidance of US. Dysphagia Outcome Severity Scale score improve from 1 to 6, Functional Oral Intake Scale score improved from 1 to 6 and penetration-aspiration scale score improved from 7 to 2 at 2 months follow-up. Solely US-guided BTX injection may be a feasible option for many rehabilitation units in managing dysphagia following LMS.