International Session 22　　SNHL 2

Background : Lateral medullary syndrome(LMS) , or Wallenberg syndrome, commonly results from posterior inferior cerebellar artery stroke and is frequently associated with severe dysphagia, sialorrhea, and aspiration due to involvement of the nucleus ambigus and disrupted bulbar coordination.These complications significantly increase morbidity and prolong dependence on Ryles tube feeding.Objective :To evaluate the therapeutic role of botulinum toxin injection in improving dysphagia and controlling sialorrhea in patients with lateral medullary syndrome.Methods :Patients with LMS presenting with persistent dysphagia and/or intractable sialorrhea despite conservative management were treated with targeted botulinum toxin injections.Botox was administered into the cricopharyngeus muscle for cricopharyngeal dysfunction(via TNE guided)and into bilateral parotid and submandibular glands for sialorrhea, under ultrasound guidance.Clinical outcomes were assessed using swallowing function, aspiration episodes, drooling severity, and feeding dependency.Results : Botulinum toxin injection resulted in significant improvement in swallowing efficiency, reduction in aspiration events, and marked control of sialorrhea.Several patients demonstrated improved tolerance to oral feeds and reduced dependence on nasogastric or gastrostomy feeding.The procedure was well tolerated with no major complications, and benefits were sustained for several months. Conclusion :Botulinum toxin injection is a safe, minimally invasive, and effective adjunctive therapy in the management of dysphagia and sialorrhea in lateral medullary syndrome.It offers a valuable therapeutic option to improve the quality of life and reduce aspiration-related morbidity in selected patients.