Percutaneous chemical myotomy using botulium neurtoxin A under local anaesthesia in the treatment of cricopharyngeal dysphagia following laryngectomy

Auris Nasus Larynx. 2010 Aug;37(4):500-3. doi: 10.1016/j.anl.2009.11.008. Epub 2009 Dec 29.

Abstract

Objective: The purpose of this study was to evaluate the outcome of the use of percutaneous injection of botulinum neurotoxin A under local anaesthesia in the management of cricophayngeus dysphagia in post-laryngectomy patients.

Methods: Fifteen post-laryngectomy patients (6 males, 9 females, age range 48-72 years) with surgery performed not less than five years with post-operative radiotherapy were recruited. Under video-fluoroscopic control and the attachment of a metal safety pin to the neck as a topographical marker for the cricopharyngeus muscle, botulinum neurotoxin was injected after local anaesthesia infiltration. Patients were followed up for a 4 months period with repeated video-fluoroscopy and telephone self-assessment and weight change.

Results: Eighty seven percent of patients noticed some improvement in their dysphagia. One patient reported an adverse reaction of pain at the site of injection.

Conclusion: Percutaneous local injection of botulinum neurotoxin A is a simple, safe and cost-effective means of improving cricopharyngeal dysphagia in post-laryngectomy patients when general anaesthesia is contra-indicated.

MeSH terms

  • Aged
  • Botulinum Toxins, Type A / therapeutic use*
  • Deglutition Disorders* / drug therapy
  • Deglutition Disorders* / etiology
  • Deglutition Disorders* / physiopathology
  • Female
  • Fluoroscopy
  • Humans
  • Laryngectomy / methods*
  • Male
  • Middle Aged
  • Neuromuscular Agents / therapeutic use*
  • Pharyngeal Muscles / physiopathology*
  • Postoperative Complications*
  • Videotape Recording

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A