title: Cricothyroid onabotulinum toxin A injection to avert tracheostomy in bilateral vocal fold paralysis.
abstract: OBJECTIVE
  More than half of children with bilateral vocal fold paralysis require a tracheostomy for airway management. We report an innovative, minimally invasive approach consisting of onabotulinum toxin A injection into the cricothyroid muscles.
  
  
  METHODS
  Onabotulinum toxin A was injected under direct vision into the cricothyroid muscles of 6 pediatric patients with bilateral abductor vocal fold paralysis. None of the patients had fold fixation on laryngoscopy performed at the time of the injection. All patients had a documented increase in airway patency as visualized on flexible laryngoscopy within days after injection. This procedure successfully averted a tracheostomy in 5 patients and permitted decannulation of the sixth patient.
  
  
  CONCLUSIONS
  Onabotulinum toxin A injection into the cricothyroid muscles leads to an increase in the glottic space, providing an adequate airway. Onabotulinum toxin A injection in the cricothyroid muscles could be offered as a safe, effective, noninvasive first-line option for patients with bilateral vocal fold paralysis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Daniel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cardona
mesh_terms: D058109:Airway Management / Q000379:methods*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007273:Injections, Intramuscular; D007821:Laryngeal Muscles; D007828:Laryngoscopy; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000209:etiology; D012135:Respiratory Sounds / Q000209:etiology; D014826:Vocal Cord Paralysis / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A