Botulinum toxin type A: an effective treatment to restore phonation in laryngectomized patients unable to voice
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Luigi Bartolomei • Sandro Zambito Marsala • Gian Paolo Pighi • Valentina Cristofori • Giuseppe Pagano • Massimo Pontarin • Manuela Gioulis • Corrado
- چاپ و سال / کشور: 2011
Description
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.
Neurol Sci (2011) 32:443–447 DOI 10.1007/s10072-011-0560-1 Received: 24 December 2009 / Accepted: 19 March 2011 / Published online: 9 April 2011
