title: The use of botulinum toxin for pediatric cricopharyngeal achalasia.
abstract: OBJECTIVE
  Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia.
  
  
  METHODS
  A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, postoperative need for nasogastric tube placement, and swallow studies.
  
  
  RESULTS
  A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed.
  
  
  CONCLUSIONS
  Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy.
authors.affiliation: Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, United States.
authors.forename: Melynda A
authors.initials: MA
authors.lastname: Barnes
authors.forename: Allen S
authors.initials: AS
authors.lastname: Ho
authors.forename: Prashant S
authors.initials: PS
authors.lastname: Malhotra
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koltai
authors.forename: Anna
authors.initials: A
authors.lastname: Messner
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D003413:Cricoid Cartilage / Q000002:abnormalities* / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D010609:Pharyngeal Muscles / Q000002:abnormalities / Q000187:drug effects*; D010614:Pharynx / Q000002:abnormalities* / Q000187:drug effects; D012189:Retrospective Studies; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins