Using botulinum toxin A to improve speech and swallowing function following total laryngectomy.
OBJECTIVE
To evaluate a technique to reduce dysfunctional spasm in the pharyngoesophageal segment (PES) in patients after laryngectomy.


METHODS
Pharyngoesophageal segment function related to voice and/or swallowing in patients who had undergone a laryngectomy was evaluated before and after the injection of botulinum toxin A.


METHODS
Academic referral medical center.


METHODS
Eight outpatients with voice and/or swallowing complaints after undergoing a total laryngectomy.


METHODS
Videofluoroscopic contrast examination was completed to identify stricture vs spasm in the PES in patients with voice and/or swallowing complaints after undergoing a laryngectomy. Lidocaine hydrochloride injection under fluoroscopic guidance was completed to facilitate immediate relaxation of spasm. After positive results with lidocaine, botulinum toxin was injected into the same area to facilitate longer-lasting benefit.


METHODS
Patient report of benefit and videofluoroscopic evaluation of PES function.


RESULTS
Six of 8 patients demonstrated improved function within the PES after lidocaine injection. Five of these 6 received transcutaneous injection of botulinum toxin. Four of the 5 patients demonstrated improved swallowing and/or voice function, and 3 of these 4 received subsequent injections of botulinum. No serious complications were encountered.


CONCLUSIONS
Transcutaneous injection of botulinum toxin in the PES under videofluoroscopic guidance provides improvement in voice and/or swallowing function without significant complications. Additional clinical study will be required to evaluate dose and technique influences on degree and duration of benefit and complications.
Crary
M A
MA
Department of Communicative Disorders, College of Health Professions, University of Florida Health Science Center, Gainesville, USA.
Glowasky
A L
AL
D000279:Administration, Cutaneous; D000368:Aged; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D004341:Drug Evaluation; D015155:Esophageal Spasm, Diffuse / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D004940:Esophageal Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D013064:Speech Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D014741:Video Recording
D001905:Botulinum Toxins