title: Botulinum neurotoxin for management of intractable central leakage through a voice prosthesis in surgical voice restoration.
abstract: Rehabilitation of voice and speech after total laryngectomy has become established practice in recent years. A voice prosthesis is placed within a surgically produced fistula between the trachea and upper oesophagus and acts as a one way valve, allowing passage of pulmonary air from the trachea into the oesophagus and preventing aspiration of food and fluid from the oesophagus into the trachea. Persistent leakage through or around these prostheses is a recognized complication, the aetiology of which can vary widely, from mechanical issues with the prostheses themselves to anatomical and physiological issues associated with the reconstructed pharynx. We report a new technique of using Dysport in the management of intractable central leakage due to premature and forceful closure of the upper oesophageal sphincter during swallowing. This resulted in the pooling of fluids around the posterior flange of the prosthesis. This, along with the increased pressure from the muscle contraction, led to central leakage, as identified on videofluoroscopy. An injection of Dysport paralysed the upper oesophageal sphincter, preventing pooling of fluids around the prosthesis and the forcing open of the valve. The effect was to eliminate the leakage, and the patient did not require further injections over the following 22 months.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Charing Cross, Hospital, London, UK. gmullan@doctors.org.uk
authors.forename: G P J
authors.initials: GP
authors.lastname: Mullan
authors.forename: M T
authors.initials: MT
authors.lastname: Lee
authors.forename: P M
authors.initials: PM
authors.lastname: Clarke
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002277:Carcinoma / Q000503:physiopathology / Q000601:surgery; D003680:Deglutition Disorders / Q000628:therapy*; D049631:Esophageal Sphincter, Upper; D005471:Fluoroscopy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000503:physiopathology / Q000601:surgery; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000139:chemically induced*; D014741:Video Recording; D014833:Voice Quality
chemical_list: D019274:Botulinum Toxins, Type A