title: Botulinum toxin type A: an effective treatment to restore phonation in laryngectomized patients unable to voice.
abstract: We evaluated the efficacy of Botulinum toxin type A (BTXA) as an alternative to surgical intervention to facilitate phonation in 34 laryngectomized patients (31 males and 3 women) who were unable to produce tracheoesophageal voice because of spasm of the middle and inferior pharyngeal constrictor muscles (PCM). EMG was recorded to confirm activity in these muscles during attempted vocalization. Parapharyngeal nerve block (Carbocaine 2%, 5 cc) was used to demonstrate short-term fluent voice after relaxation of the pharyngeal constrictor muscle. At a later occasion, 100 U of Botox (Allergan) in ten patients and 50 U in two patients were injected unilaterally at one location in the PCM percutaneously under EMG guidance. All patients then underwent a voice therapy program. In 11 out of 12 patients an improvement of phonation was evident after 24-48 h and it was long lasting. This result was also seen in a patient previously myotomized without improvement. Only one patient needed to be reinjected every 3 months. At a follow-up after 3 months the EMG recorded in four patients showed a low-amplitude or complete absence of activity in the treated muscle. No side effects developed. BTX therapy, especially when associated with the speech therapy, is efficacious in restoring voice to laryngectomees who are unable to voice because of spasm of the PCMs. Our results confirm previous reports. This method is our approach of choice in managing PCM spasm because it is non-invasive, not painful, has few or no side effects, and is frequently long-lasting.
authors.affiliation: Neurology, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bartolomei
authors.forename: Sandro
authors.initials: S
authors.lastname: Zambito Marsala
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Pighi
authors.forename: Valentina
authors.initials: V
authors.lastname: Cristofori
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pagano
authors.forename: Massimo
authors.initials: M
authors.lastname: Pontarin
authors.forename: Manuela
authors.initials: M
authors.lastname: Gioulis
authors.forename: Corrado
authors.initials: C
authors.lastname: Marchini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D003014:Clostridium botulinum / Q000737:chemistry; D055154:Dysphonia / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D009465:Neuromuscular Agents / Q000008:administration & dosage; D010609:Pharyngeal Muscles / Q000187:drug effects / Q000503:physiopathology; D010699:Phonation / Q000187:drug effects* / Q000502:physiology; D013035:Spasm / Q000188:drug therapy / Q000209:etiology / Q000534:rehabilitation; D013072:Speech, Esophageal / Q000379:methods
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A