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European Archives of Oto-Rhino-Laryngology

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27-01-2024 | Laryngectomy | Laryngology

Unlocking tracheoesophageal speech from pharyngoesophageal spasm: preliminary results of a videofluoroscopic-guided botulinum toxin A injection technique

Authors: Francesco Bandi, Francesco Chu, Valeria Zurlo, Valentina Di Natale, Stefano Zorzi, Giacomo Pietrobon, Rita De Berardinis, Marta Tagliabue, Mohssen Ansarin

Published in: European Archives of Oto-Rhino-Laryngology | Issue 4/2024

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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Title: Unlocking tracheoesophageal speech from pharyngoesophageal spasm: preliminary results of a videofluoroscopic-guided botulinum toxin A injection technique
Authors: Francesco Bandi
Francesco Chu
Valeria Zurlo
Valentina Di Natale
Stefano Zorzi
Giacomo Pietrobon
Rita De Berardinis
Marta Tagliabue
Mohssen Ansarin
Publication date: 27-01-2024
Publisher: Springer Berlin Heidelberg
Keywords: Laryngectomy
Botulinum Toxin
Published in: European Archives of Oto-Rhino-Laryngology / Issue 4/2024
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-024-08448-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Unlocking tracheoesophageal speech from pharyngoesophageal spasm: preliminary results of a videofluoroscopic-guided botulinum toxin A injection technique

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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