Botulinum toxin in speech rehabilitation with voice prosthesis after total laryngectomy.
In tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79% of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis.


OBJECTIVE
analyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheo-esophageal voice (TEV) with spasms (S) of the pharyngo-esophageal segment (PES) without myotomy.


METHODS
We analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection.


METHODS
prospective.


RESULTS
There was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT.


CONCLUSIONS
all patients with PES spasms presented vocal improvement after BT injection in the PES.
Medical School of the Campinas State University, Otorhinolaryngology and Head & Neck Discipline, Unicamp, Brazil.
Carlos Takahiro
CT
Chone
Cristiane
C
Teixeira
Nelson A
NA
Andreollo
Ana Lucia
AL
Spina
Irene H K
IH
Barcelllos
Elizabeth
E
Quagliato
Agricio N
AN
Crespo
D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage; D001905:Botulinum Toxins / Q000627:therapeutic use*; D015155:Esophageal Spasm, Diffuse / Q000188:drug therapy* / Q000503:physiopathology; D004947:Esophagus / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial; D010614:Pharynx / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D010699:Phonation / Q000502:physiology; D011446:Prospective Studies; D013072:Speech, Esophageal; D014831:Voice / Q000502:physiology
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins