Botulinum toxin: adjunctive treatment for posterior glottic synechiae.
BACKGROUND
Synechiae formation of the posterior glottis can result in tracheostomy dependence secondary to airway obstruction. Stenosis is caused by total or partial fixation of the vocal folds in adduction resulting from scar contracture. The treatment poses a management dilemma because of recurrent scar formation, made worse by mobility of the vocal folds. Although various treatment options from conservative endoscopic repair to open procedures have been proposed, the results are not satisfactory and patients often require multiple procedures.


METHODS
We present the trial of a conservative approach that includes microscopic CO2 laser resection of the scar with concomitant botulinum toxin injection of the interarytenoid and thyroarytenoid muscles of the more mobile cord. This results in a temporary paresis of the adductor muscles and hence prevents overadduction in the posterior commissure during the postoperative healing period.


METHODS
We present the surgical technique and results in three patients who underwent the procedure.


RESULTS
Treatment in all three patients was successful.


CONCLUSIONS
The appropriate use of botulinum toxin may help improve the treatment outcome of posterior synechiae of the larynx without sacrificing any laryngeal components.
Nathan
C O
CO
Department of Otolaryngology/Head & Neck Surgery, Louisiana State University Medical Center, Shreveport 71130, USA. cnatha@lsumc.edu
Yin
S
S
Stucker
F J
FJ
D000368:Aged; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005931:Glottis / Q000601:surgery; D006801:Humans; D007818:Laryngeal Diseases / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D000267:Tissue Adhesions / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome; D014827:Vocal Cords / Q000601:surgery
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins