Botox™, the trade name of botulinum toxin, is a drug produced by the same bacterial organism (Clostridium botulinum) that causes the disease process called botulism. Tiny, entirely safe quantities of this medication have been used for decades to treat strabismus, facial spasms, spasmodic dysphonia, cervical dystonia, and other neurological disorders characterized by abnormal muscle contractions. Botox is also used by cosmetic surgeons to smooth wrinkles temporarily.
Botox™ in the Context of Laryngology:
The Esophagus doesn’t like being Stretched for Years due to Untreated R-CPD
Lateral dilation from R-CPD (1 of 3)
In this middle-aged patient with R-CPD (inability to burp), now fully resolved (burping well for more than a year) after botox therapy. This view is pre-treatment, at mid-esophagus using an ENT scope. No air was insufflated to get this photo; the patient “has her own.” The aortic shelf is prominent, but observe the dramatic lateral dilation (arrows). S = spine; T = trachea.
Lateral dilation in the upper esophagus (2 of 3)
Now in the upper esophagus, arrows again depict the remarkable lateral dilation.
Medial-lateral stretch (3 of 3)
Opening of the esophagus is constant, due to the patient’s retained air, but as air goes downward transiently, the lumen size is reduced, almost accentuating the medial-lateral “stretch” of the esophagus. * denotes the same place in photos 2 and 3, for reference.
What the Esophagus Can Look Like “Below A Burp”
Baseline (1 of 3)
Mid-esophagus of a person with R-CPD who is now burping well after Botox injection into the cricopharyngeus muscle many months earlier. The esophagus remains somewhat open likely due to esophageal stretching from the years of being unable to burp and also a “coming burp.”
Pre-burp (2 of 3)
A split-second before a successful burp the esophagus dilates abruptly from baseline (photo 1) as the excess air briefly enlarges the esophagus. An audible burp occurs at this point.
Post-burp (3 of 3)
The burp having just happened, the esophagus collapses to partially closed as the air that was “inflating it” has been released.
