Bildiri_Kitabi

“Tanıdan Tedaviye Nörojenik Yutma Bozuklukları”
12-14 Nisan 2017, Ankara
TRANSORAL ENDOSCOPIC INJECTION OF BOTULINUM TOXIN
IN THE TREATMENT OF PHARYNGEAL DYSPHAGIA AFTER
STROKE
Ozan Bağış ÖZGÜRSOY 1 , Selen SEREL ARSLAN 2 , Numan DEMİR 2
1
Ankara University Faculty of Medicine Department of Otolaryngology
2
Hacettepe University Faculty of Health Sciences Department of Physiotherapy and
Rehabilitation
PURPOSE: To present a minimal invasive surgical technique than can be used
in the treatment of pharyngeal dysphagia after stroke.
MATERIAL and METHOD: A sixty-five year old male presented with
dysphagia which developed after stroke one year ago, progressed within months
and limited his oral intake. He was also suffering from irritative cough occuring
after having food. Dysphasia did not get better despite of diet modifications and
swallowing therapy. Videoflouroscopic examination revealed a cricopharyngeal
bar blocking bolus transit at the level of upper esophagial sphincter. Transoral
endoscopic injection of botulinum toxin into the cricopharygeal area was
performed under general anesthesia.
RESULTS: A liquid-soft diet was started 4 hours after surgery and the patient
was discharged at the same day. At postoperative 4th day visit, patient reported
that he was able to swallow better than that before the surgery and that irritative
cough was improved after surgery. After seeing that subjective improvement, a
follow-up visit was scheduled for 3 months later.
DISCUSSION: Pharyngeal dysphagia, when limits oral intake in stroke
patients, can lower the quality of life by causing severe medical and social
problems. Hence, diet modifications and swallowing therapy should be applied
to all symptomatic stroke patients. If there is no response to those, surgical
options can be tried. Transoral endoscopic injection of botulinum toxin is a
highly safe surgical intervention and can be done in same-day surgery setting.
Succesful results have been reported. The only disadvantage is the requirement
of general anesthesia, even it takes a short time like 10-15 minutes.
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