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The per-oral endoscopic myotomy, or POEM, is a minimally invasive surgical procedure for the treatment of achalasia wherein the inner circular muscle layer of the lower esophageal sphincter is divided through a submucosal tunnel. [1] This enables food and liquids to pass into the stomach, a process that is impaired in achalasia.
Botulinum toxin, or botulinum neurotoxin (commonly called botox), is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. [24] It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, thus causing flaccid paralysis. [25]
Chemodenervation is a process used to manage pain through the use of phenol, alcohol, or a botulinum toxin (botox). [6] [2] [14] The agent of choice is injected into or adjacent to a specific sensory nerve or into muscle fibers to dull neuronal pain signaling. [6] [2]
The external anal sphincter (or sphincter ani externus) is an oval tube of skeletal muscle fibers. [1] Distally, it is adherent to the skin surrounding the margin of the anus. [2] It exhibits a resting state of tonical contraction [1] and also contracts during the bulbospongiosus reflex. [3] [4] [5] [6]
The internal anal sphincter, IAS, or sphincter ani internus is a ring of smooth muscle that surrounds about 2.5–4.0 cm of the anal canal. It is about 5 mm thick, and is formed by an aggregation of the smooth (involuntary) circular muscle fibers of the rectum.
It is a strap-like, C-shaped muscle at the base of the throat, behind the larynx. The upper esophageal sphincter encircles the proximal (upper) opening of the oesophagus. [9] The upper esophageal sphincter has a residual tone which is in fact augmented as it is stretched open. [10] Swallowing of air during eating and drinking is normal.
The pudendal nerve is the main nerve of the perineum. [1]: 274 It is a mixed (motor and sensory) nerve and also conveys sympathetic autonomic fibers.It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum, as well as the motor supply to various pelvic muscles, including the male or female external urethral sphincter and the external anal sphincter.
The sphincter is separated either by simply stretching or cutting. Cutting the muscle prevents spasm and temporarily weakens the muscles. Both methods help the underlying area to heal. Remove the fissure and any underlying scar tissue. Suture back the wound. [4]
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