Voice failure after tracheoesophageal puncture: Management with botulinum toxin

Blitzer, Andrew; Komisar, Arnold; Baredes, Soly; Brin, Mitchell F.; Stewart, Celia

doi:10.1016/s0194-5998(95)70002-1

Cited by 50 publications

(51 citation statements)

References 10 publications

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“…Pharyngeal constrictor spasm has been associated with poor voice outcomes after primary or secondary TEP. 10 This was the most likely cause in two patients who responded to Botox© injections of the cricopharyngeal muscle segment. The third patient developed prosthesis leakage that resolved with prosthesis re-sizing.…”

Section: Discussionmentioning

confidence: 98%

Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy

Sethi¹,

Kozin²,

Lam³

et al. 2014

Otolaryngol.--head neck surg.

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The supraclavicular artery island flap (SCAIF) is increasingly employed for laryngectomy reconstruction with excellent success. Although tracheoesophageal puncture (TEP) with intraoperative prosthesis placement is also positively reported, this is not described in patients following SCAIF. We review our experience with primary TEP with prosthesis placement and voice outcomes in patients after SCAIF reconstruction. Seven patients underwent SCAIF with primary TEP after laryngectomy from 2011-2013. Five underwent total laryngectomy (TL) and two underwent TL with partial pharyngectomy. All patients had 16 French Indwelling BlomSinger prostheses placed intra-operatively without complications. Six patients achieved tracheoesophageal voice (median time =1.5 months). Two patients required cricopharyngeal segment Botox© injections. One patient remained aphonic. One patient developed prosthesis leakage addressed with prosthesis replacement. Our preliminary data demonstrates that, similar to free tissue transfer reconstruction, primary TEP with intraoperative placement of the voice prosthesis at the time of SCAIF reconstruction is safe and effective.

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Section: Discussionmentioning

confidence: 98%

Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy

Sethi¹,

Kozin²,

Lam³

et al. 2014

Otolaryngol.--head neck surg.

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“…Consequently, the pharyngeal mucosa does not vibrate, and there is no phonation. 1,[3][4][5][7][8][9]13,18 Spasm may be seen in videofluoroscopy done during phonation with the PP; 5,7,8,15,24 it is absent during swallowing when the PES relaxes. During constriction there is no relaxation when swallowing.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] There are three approaches for the treatment of PES alterations: myotomy of the middle and lower constrictors of the pharynx, neurectomy of the pharyngeal plexus, and the recently described chemical denervation of the PES with the botulinum toxin (BT). 6,7,8,10,11,[14][15][16][17][18][19][20][21][22][23] The BT is a presynaptic blocker of acetylcholine release at the neuromuscular junction. Videofluoroscopy 3,4,7,15,24 and computed manometry (CM) demonstrate relaxation of the PES following the use of BT in this region.…”

Section: Introductionmentioning

confidence: 99%

Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória

Chone

Teixeira

Andreollo

et al. 2008

Rev. Bras. Otorrinolaringol.

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In tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79% of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis. Aim: analyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheoesophageal voice (TEV) with spasms (S) of the pharyngoesophageal segment (PES) without myotomy. Materials and Methods: We analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection. Study design: prospective. Results: There was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT. Conclusion: all patients with PES spasms presented vocal improvement after BT injection in the PES.

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“…These are natural protection mechanisms against gastroesophageal reflux but in patients with TL they become an obstacle for phonation rehabilitation 10,33,34 . There are three forms of treatment for PES affection: myotomy of medial and inferior pharyngeal constrictor muscles, neurectomy of pharyngeal plexus, and recently published, the technique for chemical denervation of LPS with botulinum toxin 1,6,7,11,28,[32][33][34][36][37][38][39][40] .…”

Section: Discussionmentioning

confidence: 99%

“…The use of botulinum toxin injection in LPS was initially used to treat the spasm after TEP with insertion of VP in 1995 by Blitzer et al 38 . There are authors who have demonstrated effects up to two years and three months or more, after initial application, without the need to reapply 7,37 .…”

Section: Discussionmentioning

confidence: 99%

Reabilitação vocal pós-laringectomia total: resultados em longo prazo com prótese fonatória Blom-Singer® de longa permanência

Chone

Spina

Crespo

et al. 2005

Rev. Bras. Otorrinolaringol.

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To evaluate long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). We studied the influence of time of performance of tracheo-esophageal puncture (TEP), use of radiotherapy (XRT), patients' age and length of followup, on the rate of success of use of VP. Study Design: clinical prospective. Material and Method: Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. Both otolaryngologist and speech pathologist evaluated all patients for the vocal functional issues during the follow-up. The relative data on time of placement of VP, time of use of PF, use of XRT, age, length of follow-up and interval of duration of each VP were recorded during the follow-up. Results: There was 87% of patients with primary TEP and 13% with secondary. The follow-up varied from 12 to 87 months, with average of 38 months for primary and 51 months for secondary TEP. There were 59% of patients submitted to XRT. The general rate of success was of 94%. In primary TEP it was of 97% and in the secondary, it was 78% (p=0.07) and after two years, the success rate was of 96% in primary TEP and 75% in secondary TEP (p=0.07). The use of XRT and patient age did not influence the success of use of VP among primary and secondary TEP, independently of length of follow-up. Conclusion: Tendency to greater success rate in voice rehabilitation after TL with primary TEP was observed. Postoperative XRT and age did not influence success rate.Palavras-chave: câncer, laringe, reabilitação vocal, voz, prótese fonatória.

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Voice failure after tracheoesophageal puncture: Management with botulinum toxin

Cited by 50 publications

References 10 publications

Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy

Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy

Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória

Reabilitação vocal pós-laringectomia total: resultados em longo prazo com prótese fonatória Blom-Singer® de longa permanência

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