title: Use of botulinum toxin in voice restoration after laryngectomy.
abstract: BACKGROUND
  Following laryngectomy, a distinct population of patients fails to achieve successful tracheoesophageal voice. These patients' voices range from strained and effortful to none at all. Such patients may present with severe hypertonicity or spasm of the pharyngoesophageal segment. Botulinum toxin has been used to chemically denervate the pharyngeal musculature, and is an alternative to invasive surgical procedures. The aim of this article is to review the evidence for using botulinum toxin to achieve an improvement in post-laryngectomy voice.
  
  
  METHODS
  A Medline literature review (1966 to January 2009) and a search of the Cochrane database were performed. Foreign language articles and those not pertaining to post-laryngectomy voice restoration were excluded.
  
  
  RESULTS
  Nine articles reporting a total of 134 patients were identified. Although there were differences in the outcome measures used, objective improvement in voice production occurred in between 70 and 100 per cent of cases.
  
  
  CONCLUSIONS
  Botulinum toxin can be used as a safe and cost-effective treatment in patients with confirmed pharyngoesophageal segment hypertonicity and/or spasm following laryngectomy, to obtain an improvement in voice quality.
authors.affiliation: Head and Neck Centre, University College Hospital, London, UK. drsamk@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Khemani
authors.forename: R
authors.initials: R
authors.lastname: Govender
authors.forename: A
authors.initials: A
authors.lastname: Arora
authors.forename: P E
authors.initials: PE
authors.lastname: O'Flynn
authors.forename: F M
authors.initials: FM
authors.lastname: Vaz
mesh_terms: D019274:Botulinum Toxins, Type A / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D007267:Injections; D007825:Laryngectomy / Q000009:adverse effects* / Q000534:rehabilitation; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000534:rehabilitation; D013071:Speech, Alaryngeal; D014831:Voice / Q000187:drug effects*; D014832:Voice Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D014833:Voice Quality / Q000187:drug effects
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A