Percutaneous chemical myotomy using botulium neurtoxin A under local anaesthesia in the treatment of cricopharyngeal dysphagia following laryngectomy.
OBJECTIVE
The purpose of this study was to evaluate the outcome of the use of percutaneous injection of botulinum neurotoxin A under local anaesthesia in the management of cricophayngeus dysphagia in post-laryngectomy patients.


METHODS
Fifteen post-laryngectomy patients (6 males, 9 females, age range 48-72 years) with surgery performed not less than five years with post-operative radiotherapy were recruited. Under video-fluoroscopic control and the attachment of a metal safety pin to the neck as a topographical marker for the cricopharyngeus muscle, botulinum neurotoxin was injected after local anaesthesia infiltration. Patients were followed up for a 4 months period with repeated video-fluoroscopy and telephone self-assessment and weight change.


RESULTS
Eighty seven percent of patients noticed some improvement in their dysphagia. One patient reported an adverse reaction of pain at the site of injection.


CONCLUSIONS
Percutaneous local injection of botulinum neurotoxin A is a simple, safe and cost-effective means of improving cricopharyngeal dysphagia in post-laryngectomy patients when general anaesthesia is contra-indicated.
Natt
R S
RS
Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. ravindernatt@hotmail.com
McCormick
M S
MS
Clayton
J M
JM
Ryall
C
C
D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003680:Deglutition Disorders / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010609:Pharyngeal Muscles / Q000503:physiopathology*; D011183:Postoperative Complications; D014743:Videotape Recording
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A