Efficacy of endoscopic cricopharyngeal myotomy using a curved rigid laryngoscope in patients with sporadic inclusion body myositis: four retrospective case reviews.

Sporadic inclusion body myositis (s-IBM) is an acquired degenerative inflammatory myopathy that leads to slowly progressive muscle weakness and atrophy of the limbs, face, and pharynx. Owing to the slow progression of the disease, the indications for surgical intervention remain unclear. Herein, we retrospectively reviewed the records of four patients with s-IBM who had undergone cricopharyngeal myotomy for severe dysphagia at our institution between 2016 and 2021. Among these, one patient underwent transcervical cricopharyngeal myotomy and laryngeal suspension, as videofluoroscopic examination of swallowing revealed poor laryngeal elevation. The remaining three patients underwent endoscopic cricopharyngeal myotomy using a curved rigid laryngoscope. Preoperatively, the mean Hyodo score was 8 points (range: 6-10) using a flexible endoscope. The mean surgical duration was 104 min, and no severe complications were observed. Postoperatively, all patients achieved improvement in swallowing function and food intake. Moreover, swallowing function was maintained in all four patients even 6-12 months postoperatively. Cricopharyngeal myotomy may be a safe surgical procedure with the potential to improve swallowing function, and a Hyodo score of 6 may be considered a surgical indication for cricopharyngeal myotomy in patients with s-IBM.

Tendon Transfers for the Treatment of Finger Flexion Weakness in a Patient With Inclusion Body Myositis: A Case Report.

CASE: We describe a 71-year-old patient with inclusion body myositis (IBM), characterized by progressive atrophy and weakness in his left upper extremity. This patient underwent extensor carpi radialis longus to flexor pollicis longus and brachioradialis to flexor digitorum profundus tendon transfers in the left upper extremity to reduce IBM-related functional deficits. He had noticeable improvements in finger flexion after the transfers, which have been sustained for 2 years after the procedure. CONCLUSION: This case reinforces that this novel tendon transfer may be an effective treatment option to improve hand function and activities of daily living in patients with IBM.

Preoperative and intraoperative ultrasound aids removal of migrating plant material causing iliopsoas myositis via ventral midline laparotomy: a study of 22 dogs.

BACKGROUND: Migrating plant material is often suspected clinically to be the underlying cause of iliopsoas myositis in the dog, but cannot always be found pre- or intraoperatively. In most cases, recurrence of clinical signs is related to failure to remove the plant material. Preoperative ultrasonography can be useful to visualize migrating plant material and to determine anatomical landmarks that can assist in planning a surgical approach. The purpose of the present study was to report the role of intraoperative (intra-abdominal) ultrasonography for visualizing and removing the plant material from iliopsoas abscesses using a ventral midline laparotomy approach. RESULTS: A retrospective case series of 22 dogs with iliopsoas muscle abnormalities and suspected plant material was reported. Preoperative visualization and subsequent retrieval of the plant material was performed during a single hospitalization. In all 22 dogs, the plant material (including complete grass awns, grass awn fragments and a bramble twig) was successfully removed via ventral midline laparotomy in which intraoperative ultrasonography was used to direct the grasping forceps tips to the foreign body and guide its removal. In 11 of these 22 dogs, the plant material was not completely removed during prior surgery performed by the referring veterinarians without pre- or intraoperative ultrasonography. Clinical signs resolved in all dogs and all dogs resumed normal activity after successful surgical removal of the plant material. CONCLUSION: Intraoperative ultrasonography is a safe and readily available tool that improves success of surgical removal of plant material within the iliopsoas abscesses via ventral midline laparotomy. Moreover, ultrasonographic findings of unusual plant material can be useful in planning and guiding surgical removal, by providing information about the size and shape of the foreign body.

Inclusion body myositis and anesthesia: a case series.

STUDY OBJECTIVE: Inclusion body myositis is a painless inflammatory myopathy affecting older adults. It manifests as progressive muscle atrophy and weakness, typically affecting proximal lower extremity muscles initially but insidiously progressing to affect other muscles, including bulbar (oropharyngeal) muscles and the diaphragm, and leading to dysphagia and respiratory insufficiency. This study reviews the perioperative outcomes of patients with inclusion body myositis who received general anesthesia. DESIGN: Observational retrospective study. SETTING: Academic tertiary referral center. PATIENTS: Patients with inclusion body myositis from October 1, 2009, to September 30, 2015, undergoing procedures requiring general anesthesia. INTERVENTIONS: Perioperative health records were reviewed. MEASUREMENTS: Perioperative outcomes and complications were assessed, with emphasis on respiratory complications and unexpected reactions to succinylcholine and nondepolarizing neuromuscular blocking drugs. MAIN RESULTS: Sixteen patients with inclusion body myositis underwent 18 procedures requiring general anesthesia. Succinylcholine was used during induction in 6 cases (33.3%) and nondepolarizing neuromuscular blocking drugs in 11 cases (61.1%). For 13 patients (72.2%), the trachea was extubated at the end of surgery, and none had postoperative respiratory complications. The 5 patients who continued to have tracheal intubation were expected to require continuous mechanical ventilation postoperatively. Three patients died within 30 days of surgery. One patient underwent a tracheostomy for planned long-term mechanical ventilation but life support was withdrawn after 22 days, and 2 severely deconditioned patients died at 11 and 15 days following general anesthesia for endoscopic procedures. CONCLUSIONS: Our patients with inclusion body myositis had uneventful perioperative outcomes following general anesthesia with depolarizing and nondepolarizing muscle relaxants. The small patient cohort in our series precludes a definitive conclusion regarding the safety of anesthetic agents in this patient population.

Cricopharyngeal myotomy for cricopharyngeus stricture in an inclusion body myositis patient with hiatus hernia: a learning experience.

Inclusion body myositis is a chronic progressive myopathy which tends not to respond to steroids and immunosuppressive treatments. Dysphagia is more common in this group than other inflammatory myopathies like polymyositis and dermatomyositis. Otolaryngologists are involved in the management of dysphagia in inclusion body myositis. They usually use a combination of cricopharyngeal myotomy, upper oesophageal dilation or botulinum injection to help with the symptoms. Cricopharyngeus myotomy is the preferred treatment in this group and patients tend to be discharged after a short stay in the hospital. However, our experience was completely different from what we expected as a relatively straightforward procedure led to severe morbidity and prolonged hospital admission due to continuous acid reflux and aspiration. We believe that the presence of hiatus hernia led to this problem as the patient's problem resolved completely after her hernia was treated.

Inflammatory myopathy causing pharyngeal dysphagia: a new entity.

Seven patients presented to our swallowing center with solid food dysphagia. The age range at presentation was 69 to 90 years. All patients had normal findings on neurologic evaluation, and in those patients undergoing electromyography and nerve conduction studies, results of all such tests were also normal. Pooling of saliva in the pharyngeal recesses was noted on fiberoptic laryngoscopy in most cases. The swallowing videofluoroscopy findings were strikingly similar. All patients had a prominent cricopharyngeus muscle, and some had a prominence in a more proximal portion of the inferior constrictor muscle. All patients had decreased epiglottic tilt and moderate or severe residue in the pharyngeal recesses. Three patients underwent pharyngoesophageal sphincter myotomy. Biopsies of the omohyoid and cricopharyngeus muscles showed inflammatory myopathy with no evidence of inclusion bodies. This is a distinct clinical entity defined by isolated pharyngeal dysphagia in elderly patients with a unique videofluoroscopic appearance and pharyngeal myopathy.