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

Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

“…15,36,40,44,49,53 Translation of the results to best clinical decision making is not possible in 18 studies because the methodology and results were not described in sufficient detail to warrant doing so. 14,16,19,20,26,27,30,33,34,40,46,47,[51][52][53][54][55][56] Information on the number of raters and how exams were evaluated was missing in almost all studies. Only in five studies were the raters blinded 15,18,26,48,49 and only in three studies was information given on interobserver or intraobserver reliability.…”

“…[36][37][38][39][40][41][42][43][44] All case series were classified as level C evidence. [45][46][47][48][49][50][51][52][53][54][55][56] None of the 44 articles met all critical appraisal criteria (Table 3). Seventeen articles fulfilled all criteria for external validity, 13,17,22,[26][27][28]30,32,35,36,[38][39][40]44,46,49,50 and six studies did not fulfill any of these criteria.…”

“…14,19,33,34,42,45 Two of the included articles fulfilled all criteria for internal validity, 18,48 representing a low risk of bias. Fourteen articles met only 2-3 criteria for internal validity, 14,16,19,27,30,33,36,40,[51][52][53][54][55][56] indicating a high risk of bias. Thirty studies applied statistical analytic methods.…”

“…In 14 studies, extrapolation of the results to all TLE patients can be compromised due to the poor internal validity or small sample sizes (≤20 study participants) 18,19,31,[46][47][48][49][50][51][52][53][54][55][56]. In two studies, patients with OD were included, but no information was provided on how OD was diagnosed 45,52. Study aims and explanation for dropouts were reported in the majority of the studies.…”

‘Endoflip® evaluation of pharyngo‐oesophageal segment tone and swallowing in a clinical population: a total laryngectomy case series’

“…Interventions commonly employed to optimise pharyngo‐oesophageal segment tone, and hence, voice and swallowing post total laryngectomy include endoscopic dilation procedures, myotomy, pharyngeal neurectomy and botulinum toxin injections to the cricopharyngeus (CP) muscle within the pharyngo‐oesophageal segment . However, candidacy for and effectiveness of these interventions can be quite subjective based on unreliable measures obtained from videofluoroscopy and manometry examinations (Fig. c).…”