title: The role of botulinum toxin in the management of airway compromise due to bilateral vocal fold paralysis.
abstract: OBJECTIVE
  The management of a patient with bilateral vocal fold motion impairment (BVFMI) can be challenging for the otolaryngologist. The treatment traditionally involves tracheotomy, which can be very distressful for some patients. Alternatively, there are endoscopic procedures, which irreversibly sacrifice voice in order to improve airway. The optimal treatment of BVFMI still eludes us. The purpose of this review is to highlight an alternate management strategy for bilateral vocal fold paralysis using botulinum toxin (BTX). This procedure is predicated on the premise that vocal fold immobility is related to synkinetic reinnervation of the vocal fold. Eliminating any thyroarytenoid/lateral cricoarytenoid (LCA) activity during respiratory gestures should allow greater unopposed posterior cricoarytenoid abduction.
  
  
  RESULTS
  There have been several case reports and series, the largest of which involved 11 patients, describing the successful use of BTX for this application.
  
  
  CONCLUSIONS
  The best candidates for this adductor chemical denervation are those patients who have undergone trauma to the recurrent laryngeal nerve without evidence of cricoarytenoid joint fixation. Patients should have evidence of voluntary thyroarytenoid/LCA laryngeal electromyography activity, though true synkinesis cannot always be reliably identified. The procedure can be another management option for patients with BVFMI.
authors: Baylor College of Medicine, Texas Children's Hospital, TX, USA.
authors: Julina
authors: J
authors: Ongkasuwan
authors: Mark
authors: M
authors: Courey
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D004576:Electromyography; D006801:Humans; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology; D046608:Synkinesis / Q000503:physiopathology; D014826:Vocal Cord Paralysis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins