PMC9811257_01
A space-time diagram of high-resolution manometry before and after treatment. The x-axis represents time (dotted arrow indicates 2 s), and the y-axis represents the distance from the nostril. Each pressure was assigned a color (legend, left). (A) When swallowing 3 ml of thick liquid before treatment on April 6, 2021, the UES resting pressure and UES residual pressure increased, while the coordination of pharyngeal contraction and UES relaxation was normal. (B) Resting pressure in the resting state before treatment on April 6, 2021. (C) When swallowing 3 ml of thick liquid after treatment on July 22, 2021, the UES resting pressure and UES residual pressure dropped to normal. (D) The resting pressure in the resting state after treatment on July 22, 2021, was a more straightforward indication of improvement. The white arrow indicates the UES residual pressure. The dotted box indicates swallowing. UES, upper esophageal sphincter.
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F1
Although the UES resting pressure was within the normal range (76.6 mmHg; normal reference range: 34-104 mmHg), the space-time diagram was quite red, indicating high pressure (Figures 1A,B). Re-examination of FEES and VFSS on July 22, 2021, was normal, and the UES residual pressure dropped to normal levels during swallowing (5.5 mmHg), as did the UES resting pressure (Figures 1C,D).
Ultrasound imaging of the cricopharyngeal muscle during the operation. (A) The ultrasound imaging of the cricopharyngeal muscle during the operation. The blue arrow shows the cricopharyngeal muscle under catheter balloon guidance. The dotted line indicates the expected injection path. (B) The ultrasound imaging of the cricopharyngeal muscle and catheter balloon with margins drawn. The red circle shows the cricopharyngeal muscle. The blue circle shows the catheter balloon. (C) The cartoon of cricopharyngeal muscle and adjacent structures.
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F2
April 29, 2021 (Figure 2). BTX injection with combined guidance has been skillfully used in clinical practice. A catheter balloon was inserted into the esophagus through the nasal cavity, and 5 ml of water was injected into the balloon.