Figure 14: Case study of a patient who suffered ischemia of the dorso-lateral medulla oblongata. He suffered from severe dysphagia with recurrent aspiration, and a tracheotomy was necessary. The esophageal introitus was completely closed by the musculature. This can be seen on the left - a pool of contrast medium spills into the larynx and trachea down to the inflated cuff of the cannula. No appreciable improvement was seen after treatment with baclofen (centrally acting muscle relaxant). This was supplemented by the circular injection of 75 units of Botox ® in the muscles of the esophageal introitus. In addition, a total dose of 70 units of Botox ® was injected bilaterally into the submandibular and parotid glands (22.5 units into each parotid, 12.5 into each submandibular gland). The control examination three weeks after the injections revealed a completely unimpaired passage of the contrast medium (right side of illustration). The PEG tube was removed, and the patient was discharged to a rehabilitation facility without dysphagia or aspiration.