Article ; Online: Unlocking tracheoesophageal speech from pharyngoesophageal spasm: preliminary results of a videofluoroscopic-guided botulinum toxin A injection technique.
2024 Volume 281, Issue 4, Page(s) 1885–1893
Abstract: Purpose: The tracheoesophageal puncture for the voice prosthesis (VP) placement is the recognized gold standard in post-laryngectomy voice rehabilitation. Despite the development of specific intraoperative techniques, a subset of patients will suffer ... ...
| Abstract | Purpose: The tracheoesophageal puncture for the voice prosthesis (VP) placement is the recognized gold standard in post-laryngectomy voice rehabilitation. Despite the development of specific intraoperative techniques, a subset of patients will suffer from poor functional outcomes due to pharyngoesophageal spasms (PES). This paper evaluates the functional outcomes after transcutaneous botulinum toxin type A (BTX-A) infiltration for PES with a videofluoroscopy-guided technique. Methods: Since 2022, eight consecutive patients with VP and affected by PES were treated with BTX-A injection by a standard videofluoroscopic guided technique at the European Institute of Oncology, IRCCS (IEO) in Milan. A lidocaine test was performed pre-operatively to evaluate the potential effect of chemical neurectomy. All patients with positive lidocaine tests were injected with 50 IU of BTX-A (Allergan, Irvine, CA) according to the sites marked during the videofluoroscopy. Reported symptoms (VHI, SECEL), perceptual (INFVo), aerodynamic (MPT) and manometric parameters were collected before and after treatment. Results: In all cases, BTX-A was performed as an outpatient procedure without complications. For seven patients, only one BTX-A injection was needed, while one patient required a re-injection. Subjective and perceptive improvement after BTX-A was significant for VHI, SECEL and INFVo. MPT showed significant improvement after a chemical neurectomy. After a mean follow-up of 6 months, all patients maintained a good TES quality. Conclusion: The videofluoroscopic guided BTX-A injection of the pharyngoesophageal tract showed to be a feasible and reproducible technique in all cases. The pharyngoesophageal videofluoroscopy allows defining of patients' anatomical landmarks that help the surgeon to perform a homogeneous injection, empowered by post-injection massage. |
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| MeSH term(s) | Humans ; Botulinum Toxins, Type A ; Speech ; Laryngectomy/adverse effects ; Speech, Esophageal ; Spasm/etiology ; Lidocaine ; Treatment Outcome |
| Chemical Substances | Botulinum Toxins, Type A (EC 3.4.24.69) ; Lidocaine (98PI200987) |
| Language | English |
| Publishing date | 2024-01-27 |
| Publishing country | Germany |
| Document type | Journal Article |
| ZDB-ID | 1017359-6 |
| ISSN | 1434-4726 ; 0937-4477 |
| ISSN (online) | 1434-4726 |
| ISSN | 0937-4477 |
| DOI | 10.1007/s00405-024-08448-9 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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