title: Botulinum toxin in the treatment of post-radiosurgical neck contracture in head and neck cancer: a novel approach.
abstract: Neck pain affects a third of patients following head-and-neck cancer treatment, whether by radiation therapy or surgery. It is a disabling condition and the associated muscle contractures impair cervical motion. Type-A botulinum toxin is an analgesic and muscle relaxant, able to improve patients' quality of life. We here report our experience with botulinum toxin in post-radiosurgical neck contracture.
  
  
  METHODS
  A single-center pilot study was run from January 2007 to July 2008, respecting the Declaration of Helsinki. All patients in complete remission from head-and-neck cancer with post-radiosurgical neck contracture impairing neck motion were included. Pain and functional impairment were assessed on a neck-function disability scale before and 1 month after botulinum toxin injection. Efficacy duration was measured. Complications at the injection site or related to drug diffusion were investigated.
  
  
  RESULTS
  Nine consecutive patients (six male, three female; mean age, 61 years [range, 52-73 years]) were included. In six patients, the sternocleidomastoid muscle was injected and the muscular pedicle of a pectoralis major flap in three. Mean cervical disability score fell significantly from 33 to 23 (P=0.01). There were no complications. Efficacy was seen at a mean 6 days, and analgesia and muscle relaxation lasted for a mean 19 days.
  
  
  CONCLUSIONS
  In post-radiosurgical neck contracture, botulinum toxin injection is a simple and easy procedure able to improve neck motion and reduce neck pain in head-and-neck cancer patients. A phase-II prospective study to determine injection sites and dosage should help bear out these preliminary findings.
authors: Service de chirurgie ORL et cervicofaciale, hôpital Foch, 40 rue Worth, Suresnes, France. christine.bach@hopital-foch.org
authors: C-A
authors: CA
authors: Bach
authors: I
authors: I
authors: Wagner
authors: X
authors: X
authors: Lachiver
authors: B
authors: B
authors: Baujat
authors: F
authors: F
authors: Chabolle
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003286:Contracture / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000188:drug therapy*; D011832:Radiation Injuries / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A