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Lee JH, Lee HJ, Kim BH. Ultrasound-Guided Botulinum Neurotoxin Injection for Alleviating Cricopharyngeus Muscle Spasticity: A Cadaveric Feasibility Study with Nerve Ending Analysis. Toxins (Basel) 2024; 16:317. [PMID: 39057957 PMCID: PMC11281226 DOI: 10.3390/toxins16070317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Botulinum neurotoxin (BNT) injection into the cricopharyngeus muscle (CPM) under ultrasound (US) guidance is a minimally invasive technique performed to relieve cricopharyngeal dysphagia by reducing CPM spasticity. This technique is basically accessible only to both lateral sides of the CPM. This cadaveric study aimed to evaluate whether US-guided injection could effectively deliver BNT to abundant areas of gross nerve endings within the CPM. We utilized a newly modified Sihler's staining method to identify regions with abundant neural endings within the CPM while preserving the three-dimensional morphology of the muscle in 10 sides of 5 fresh cadavers. A mixture of 0.2 mL dye was injected into the 16 sides of CPM under US guidance in 8 cadavers. Nerve endings were abundant in posterolateral areas of the CPM; the injected dye was identified at the posterolateral area on 12 sides (12/16 side, 75%) without diffusion into the posterior cricoarytenoid muscle. The injection failed on four sides (two sides of the prevertebral fascia and two sides of the esophagus below the CPM). These results suggest that US-guided injection could be a feasible technique as it can deliver BNT to the most abundant nerve distribution areas within the CPM in most cases.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, 1332, Seongnam-daero, Seongnam 13120, Republic of Korea;
| | - Hyung-Jin Lee
- Department of Anatomy, CHA University School of Medicine, 335, Pangyo-ro, Seongnam 13448, Republic of Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, College of Medicine, 27 Dongguk-ro, Goyang 10326, Republic of Korea
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Abramson ZR, Nagaraj UD, Lai LM, Liu CCY, Schroeder JW, Khanna PC, Chuang NA, Strauss S, Gomez G, Clarke R, Singh S, Choudhri AF, Whitehead MT. Imaging of pediatric head and neck tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30151. [PMID: 36546312 PMCID: PMC10644272 DOI: 10.1002/pbc.30151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Zachary R Abramson
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Usha D Nagaraj
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lillian M Lai
- Department of Radiology, University of Iowa Hospitals and Clinics and Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Christopher Cheng-Yu Liu
- Department of Otolaryngology, Pediatric Otolaryngology Division, UT Southwestern Medical Center and Children's Health Dallas, Dallas, Texas, USA
| | - Jason W Schroeder
- Department of Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Paritosh C Khanna
- Department of Radiology, Rady Children's Hospital, University of California, San Diego, California, USA
| | - Nathaniel A Chuang
- Department of Radiology, Rady Children's Hospital, University of California, San Diego, California, USA
| | - Sara Strauss
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Gabriel Gomez
- University of Southern California, Keck School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Rebekah Clarke
- Department of Radiology, University of Texas Southwestern Medical Center and Children's Health Dallas, Dallas, Texas, USA
| | - Sumit Singh
- Department of Radiology, University of Texas Southwestern Medical Center and Children's Health Dallas, Dallas, Texas, USA
| | - Asim F Choudhri
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Departments of Radiology, Ophthalmology, and Neurosurgery, University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee, USA
| | - Matthew T Whitehead
- Department of Radiology, Children's National Hospital, Washington, District of Columbia, USA
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Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction. Toxins (Basel) 2022; 14:toxins14050321. [PMID: 35622568 PMCID: PMC9147508 DOI: 10.3390/toxins14050321] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Dysphagia associated with upper esophageal sphincter (UES) dysfunction remarkably affects the quality of life of patients. UES injection of botulinum toxin is an effective treatment for dysphagia. In comparison with skeletal muscles of the limb and trunk, the UES is a special therapeutic target of botulinum toxin injection, owing to its several anatomical, physiological, and pathophysiological features. This review focuses on (1) the anatomy and function of the UES and the pathophysiology of UES dysfunction in dysphagia and why the entire UES rather than the cricopharyngeal muscle before/during botulinum toxin injection should be examined and targeted; (2) the therapeutic mechanisms of botulinum toxin for UES dysfunction, including the choice of injection sites, dose, and volume; (3) the strengths and weaknesses of guiding techniques, including electromyography, ultrasound, computed tomography, and balloon catheter dilation for botulinum toxin injection of the UES.
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Bedside sonography for the diagnosis of esophageal food impaction. Am J Emerg Med 2017; 35:720-724. [DOI: 10.1016/j.ajem.2017.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/15/2016] [Accepted: 01/07/2017] [Indexed: 01/08/2023] Open
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Imaging in Thoracic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae. Insights Imaging 2014; 5:253-79. [PMID: 24519789 PMCID: PMC3999368 DOI: 10.1007/s13244-014-0309-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/20/2013] [Accepted: 01/10/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. METHODS This is a narrative review combined with a structured Medline literature search. RESULTS Ultrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size. CONCLUSIONS Ultrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits. TEACHING POINTS • Ultrasonography is becoming essential in management of the upper and lower airways. • The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation. • Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax. • Point-of-care ultrasonography of the airways has a steep learning curve. • Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.
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Affiliation(s)
- Michael S Kristensen
- Department of Anaesthesia, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Denmark,
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Palabiyik FB, Bayramoglu S, Guner NT, Daglar S, Cimilli T. Use of sonography for evaluation of the cervical and thoracic esophagus in children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1375-1379. [PMID: 22922617 DOI: 10.7863/jum.2012.31.9.1375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the normal sonographic appearance of the cervical and thoracic esophagus and to provide corresponding measurements in healthy children. METHODS In this prospective study, 93 children (51 girls and 42 boys) 1 to 15 years of age were examined sonographically. With the patient in a supine position for evaluation of the cervical esophagus, the ultrasound transducer was placed on both sides of the trachea. To evaluate the thoracic esophagus, the hands were raised over the head, and the ultrasound transducer was placed along the left side of the sternum. The length of the cervical esophagus was measured longitudinally, and the anteroposterior and transverse diameters of the cervical and thoracic esophagus were measured transversely, as was the thickness of the cervical esophageal wall. RESULTS The cervical esophagus was identified in all of the children, whereas the thoracic esophagus was shown in 41 (44%) of the 93 participants. The length of the cervical esophagus and anteroposterior and transverse diameters of the cervical and thoracic esophagus increased with age. The mean thickness of the cervical esophagus was 2.8 mm at all ages. The cervical esophageal wall appeared as 5 layers on the sonograms, and the lumen was distinct. CONCLUSIONS Evaluation of the cervical esophagus was readily achievable with sonography in children, whereas visualization of the thoracic esophagus was difficult because of the deep location, small size, and influence of bones and gas in the lungs. Conventional sonography can be easily used in the evaluation of cervical esophageal diseases in children.
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Affiliation(s)
- Figen B Palabiyik
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, 11 Tevfik Saglam Ave, 34147 Zuhuratbaba, Bakirkoy, Istanbul, Turkey.
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KRISTENSEN MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand 2011; 55:1155-73. [PMID: 22092121 DOI: 10.1111/j.1399-6576.2011.02518.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2011] [Indexed: 12/19/2022]
Abstract
In this study, it is described how to use ultrasonography (US) for real-time imaging of the airway from the mouth, over pharynx, larynx, and trachea to the peripheral alveoli, and how to use this in airway management. US has several advantages for imaging of the airway - it is safe, quick, repeatable, portable, widely available, and it must be used dynamically for maximum benefit in airway management, in direct conjunction with the airway management, i.e. immediately before, during, and after airway interventions. US can be used for direct observation of whether the tube enters the trachea or the esophagus by placing the ultrasound probe transversely on the neck at the level of the suprasternal notch during intubation, thus confirming intubation without the need for ventilation or circulation. US can be applied before anesthesia induction and diagnose several conditions that affect airway management, but it remains to be determined in which kind of patients the predictive value of such an examination is high enough to recommend this as a routine approach to airway management planning. US can identify the croicothyroid membrane prior to management of a difficult airway, can confirm ventilation by observing lung sliding bilaterally and should be the first diagnostic approach when a pneumothorax is suspected intraoperatively or during initial trauma-evaluation. US can improve percutaneous dilatational tracheostomy by identifying the correct tracheal-ring interspace, avoiding blood vessels and determining the depth from the skin to the tracheal wall.
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Affiliation(s)
- M. S. KRISTENSEN
- Department of Anaesthesia and Operating Theatre Services 4231; Center of Head and Orthopaedics; Copenhagen University Hospital; Rigshospitalet; Denmark
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Wang CP, Chen TC, Lou PJ, Yang TL, Hu YL, Shieh MJ, Ko JY, Hsiao TY. Neck ultrasonography for the evaluation of the etiology of adult unilateral vocal fold paralysis. Head Neck 2011; 34:643-8. [DOI: 10.1002/hed.21794] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2011] [Indexed: 11/09/2022] Open
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Kacar S, Uysal S, Kuran S, Dagli U, Ozin Y, Karabulut E, Sasmaz N. Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry. World J Gastroenterol 2007; 13:5245-52. [PMID: 17876896 PMCID: PMC4171307 DOI: 10.3748/wjg.v13.i39.5245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the gastroesophageal refluxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) findings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS findings as a predictor of gastroesophageal reflux (GER).
METHODS: In 45/500 patients, refluxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduodenoscopy (EGD), 24-h pH monitoring and manometry.
RESULTS: The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n = 20) [Includes Group B: isolated proximal reflux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no reflux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F reflux-negatives with HSE (n = 18), and Groups A + F reflux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry findings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 ± 1.3 vs 3.9 ± 1.4 mm). In 27/38 patients, there was at least one pathologic acid reflux and/or pathologic manometry finding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PR between Groups B + D and E (AUC = 0.775, P = 0.015).
CONCLUSION: Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT.
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Affiliation(s)
- Sabite Kacar
- Gastroenterology Department, Turkiye Yuksek Ihtisas Hospital, Dikmen Cad 220/A, No 17 Dikmen, Ankara, Turkey
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