Botulinum neurotoxin for pharyngeal constrictor muscle XXXX in tracheoesophageal voice restoration.

@entity1 @entity2507 @entity2473 @entity4372
OBJECTIVES/HYPOTHESIS: The purpose of the study was to evaluate the effectiveness of Botulinum neurotoxin (Botox) for elimination of pharyngeal constrictor muscle @entity2473 in tracheoesophageal voice restoration. STUDY DESIGN: A retrospective review was made of 62 @entity1 between 1991 and 2002 who had Botox as the initial treatment for pharyngeal constrictor muscle @entity2473 . METHODS: One hundred units of Botox properly diluted in 3 mL saline was instilled unilaterally under electromyographic guidance after fluoroscopic identification and marking of the contracted pharyngeal constrictor muscles. The @entity1 were divided into three groups based on their response to the first Botox injection: group I, complete relaxation of the pharyngeal constrictors resulting in fluent voice, intratracheal phonation pressure of 20 to 40 cm @entity2507 , and the ability to say 15 to 20 uninterrupted syllables; group II, @entity4372 or incomplete relaxation of the pharyngeal constrictors resulting in intratracheal phonation pressure of 45 to 70 cm @entity2507 and the ability to say 7 or 8 syllables; and group III, failure to produce relaxation of the pharyngeal constrictors. RESULTS: After the first injection of Botox, 49 (79%) @entity1 were in group I or II (41 in group I and 8 in group II) and group III consisted of 13 @entity1 . Thirty-four @entity1 (55%) had group I (28) or II (6) responses for greater than 6 months. A second Botox injection enabled 6 of the 13 failures to move into group I. In all, 8 pharyngeal constrictor muscle myotomies (13%) were ultimately required in the 62 @entity1 . The group I speaker for the longest period has enjoyed 11 years of fluency and successful daily use of a tracheostoma valve after two Botox injections. CONCLUSION: Botox relaxation of the pharyngeal constrictor muscles has proven to be effective, has replaced secondary pharyngeal myotomy for the initial treatment of pharyngeal muscle @entity2473 , and is the only treatment in @entity1 who are not candidates for elective surgery. Radiographic assessment, electromyographically monitored injection, and the number of Botox units appear to be important to successful outcomes.
