PDF(Pubmed)
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.
摘要：
在超声（US）指导下将肉毒杆菌神经毒素（BNT）注射到环咽肌（CPM）是一种微创技术，可通过减少CPM痉挛来缓解环咽吞咽困难。该技术基本上仅可用于CPM的两个横向侧。这项尸体研究旨在评估US指导的注射是否可以有效地将BNT递送到CPM内的大量神经末梢区域。我们利用新修改的Sihler染色方法来识别CPM内具有丰富神经末梢的区域，同时保留5具新鲜尸体10侧肌肉的三维形态。在美国指导下，将0.2mL染料的混合物注入8具尸体中的CPM的16侧。CPM的后外侧区域有丰富的神经末梢；在12侧的后外侧区域（12/16侧，75％）没有扩散到环叉后肌。四侧（椎前筋膜两侧和CPM下方食管两侧）注射失败。这些结果表明，US引导的注射可能是一种可行的技术，因为在大多数情况下，它可以将BNT输送到CPM内最丰富的神经分布区域。
